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Background: The documentation of patient data on health records is a vital component of the care process. Accurate and complete recording of this data is a necessary practice. The adoption of electronic health records to improve the quality of nursing documentation is on the rise. Objectives: This study compares the accuracy and completeness of pressure ulcer data documentation between electronic and paper records. Design: A descriptive, comparative design with a retrospective review of patient records. Settings and sample: Two hospitals were chosen purposefully, one using electronic recording of patient data and the other using paper records. Methods: In the first phase, all hospitalised patients aged 18 years and over were inspected for pressure ulcers. In the second phase, the files of patients with pressure ulcers were audited. Results: Of the 52 patients with ulcers found in the hospital that used an electronic system, 43 of their records documented the pressure ulcers (83%). Of the 55 patients with pressure ulcers in the hospital using paper records, 39 files had corresponding documentation of the presence of a pressure ulcer (71%). Conclusion: In terms of accuracy and completeness, more comprehensive documentation practice was found on the electronic health records compared with paper records. However, both types of systems have shortcomings in the practice of pressure ulcer data documentation. [ABSTRACT FROM AUTHOR]

Venous leg ulcer treatment is frequently discontinued in hospitals in contravention of national guidance, significantly affecting patient outcomes and increasing NHS costs. Aim: To identify, from the published literature, reasons for variable implementation. Method: Systematic review with narrative synthesis, including full papers in English with empirical qualitative data. Synonyms for venous leg ulcer, compression therapy and secondary care were searched across a range of health-related databases. The Critical Appraisal Skills Programme (CASP) checklist determined study quality, and meta-ethnography was used for data synthesis. Results: 7040 titles and abstracts and 41 full-text papers were screened with four papers selected. Three key themes were generated: educational needs surrounding implementation of compression therapy, patient factors regarding adherence and organisational resources including availability of appropriate equipment and trained staff. Conclusion: Barriers at the ward level were identified. There is a need to better understand why hospitals are not addressing them. [ABSTRACT FROM AUTHOR]

Background The author conducted a review on how power and hierarchy affect staff safety in maternity services, using a narrative synthesis of staff voices from relevant literature. The review was coded using NVivo software. This article aims to evaluate NVivo as a tool for thematic narrative synthesis. Methods Selected papers were coded inductively using NVivo software, a subjective idealist approach to knowledge where iteration is achieved at the coding and synthesis stages of the process. Results NVivo proved to be a versatile tool; the imported files could be word or pdf, the import tab made it possible to upload images and audio files and information could be transferred from OneNote, Outlook and bibliographic software such as Endnote and RefWorks. NVivo software provided numerous options to explore data within different tabs. Users could create relationships between files and there were opportunities to display the findings in word clouds, hierarchies and clusters. Conclusions NVivo was a user-friendly tool for a novice user, facilitating coding for thematic narrative synthesis. A discussion of the review findings were explored in a previous article. [ABSTRACT FROM AUTHOR]

Background: There are considerable tensions for healthcare staff between their employee allegiance and contracts, patient safety, and their responsibilities to codes of conduct within professional registration, and the NHS Constitution. Aims: The research aim was to identify how power and hierarchy influence staff safety in maternity services and this was achieved by reviewing research papers concerned with personal narratives of staff experiences and perspectives of employment in their profession. Methods: This systematic narrative review was based on the approach of a narrative synthesis, with papers coded using Nvivo software. Findings: Power and hierarchy influence staff safety in maternity services by creating challenges to staff safety, which appear to essentially derive from poor communication. The workplace adversity described by participants seems to be linked with 1) psychological vulnerability 1.1) anxiety about the job, and 1.2) dysfunctional relationships, alongside 2) working conditions 2.1) poor organisational and structural conditions 2.2) institutional normalisation of dysfunctional relationships and 2.3) interpersonal elements feeding into an obstructive culture. Conclusion: The negative influences of the cultural concepts of power and hierarchy on staff safety are significant within maternity services. Disconfirmation findings, those which stood out as different from the rest, evidenced the possibilities that healthy, psychologically safe working conditions could offer for healthcare staff in improving their prevailing culture. [ABSTRACT FROM AUTHOR]

Background: This is the second paper in a two-part series; the first paper was published in volume 29, issue 4 of the British Journal of Midwifery. The qualitative phase of the Baby Skin Integrity Comparison Survey (BaSICS) study was designed to address a dearth of information about research recruitment and retention, and how mothers make decisions about neonatal skincare. Aims: The aim of the qualitative phase of the BaSICS study was to explore participants' experience of participating in the research and how this interrelated with the experience of newborn skincare. Methods: Semi-structured, face-to-face or telephone interviews were used to collect data. Interviews were transcribed verbatim. Data analysis used both software and manual methods. Findings: Motivation included both altruism and personal benefits. The bespoke smartphone application was a convenient and easy tool for data collection, and being afforded full responsibility for observing and recording infant skin condition increased mothers' awareness of skin changes. Family, friends and the internet were the most commonly used sources of information about baby skincare. Conclusion: The qualitative interview component of the BaSICS study provided information that could not have been deduced from the daily survey and final questionnaire alone. This provides valuable guidance for future research in the field of infant skincare. [ABSTRACT FROM AUTHOR]

COVID-19 symptoms range from severe respiratory failure to mild anorexia, cough and smell and taste alterations, adversely impacting nutritional intake. The aim of this paper was to establish malnutrition risk, Nutrition Impact Symptoms (NIS) and associations with reduced oral intake. A retrospective observational cohort of all people testing positive for COVID-19 was conducted. Malnutrition risk, nutritional status, weight, reduced oral intake and NIS on and during admission were collected. Dietetic consultation frequency and mode were captured. Some 80% (48/60) of participants reported at least one NIS, and 58% (25/60) reported two or more. Most frequent reported symptoms were cough (60%), sore throat (35%) and reduced appetite (28%). Significant associations existed between ≥2 NIS (p=0.006), reduced appetite (p=0.000) and reduced oral intake, with 20% requiring ongoing nutrition support and consultation. High NIS prevalence confirms systematised nutrition support pathways are indicated through incorporation into standard care across the healthcare continuum, including community care. [ABSTRACT FROM AUTHOR]

Background: Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. Aim: The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. Method: A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. Findings: More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. Conclusion: The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence. [ABSTRACT FROM AUTHOR]

Objective: NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice. Method: A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed. Results: The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance. Conclusion: In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer's recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool. Declaration of interest: The authors confirm that there are no study sponsors. The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Several industry funded studies between 2001–2018 have compared the use of a single brand of baby wipes to cleansing with water and either cloth or cotton wool during nappy changes. All of these studies found that wipes were safe and effective from birth. Recommendations from these studies have included the need for brand or formula comparison but to date, no previous study has done this. Aims: The 'Baby skin integrity comparison survey' (BaSICS) study was designed to compare three brands of baby wipes to determine if there was any difference in the incidence of irritant diaper dermatitis (IDD or nappy rash) during the first eight weeks of life. Methods: Mothers who were allocated to a single brand of nappy but divided into three baby wipe allocation groups, collected and reported survey data on infant skin integrity during one nappy change daily with the use of a user-friendly smartphone application. Findings: All brands of wipes were acceptable to mothers and safe and effective when cleaning during nappy changes. The brand containing the fewest ingredients showed a clinically significant advantage of fewer incidents of rash than the other two brands. Conclusion: This study demonstrated that wipe formulation is a significant factor in prevention or reduction of IDD during the first eight weeks of life. [ABSTRACT FROM AUTHOR]

Objective: To quantify the reduction in wound size and change in wound quality following low-cost topical oxygen therapy (TOT) in patients with acute traumatic musculoskeletal wounds of the foot and ankle. Method: This prospective interventional study included patients with acute traumatic musculoskeletal wounds of the foot and ankle of <3 weeks' duration after they had undergone debridement and required subsequent wound coverage. A sterile C-Arm cover was used to cover the wound and 100% oxygen was administered at 1 atm, at a rate of 10l/min for 90 minutes on each of four consecutive days, through a suction catheter connected to an oxygen cylinder. The cycle was repeated after a three-day break. Wound surface area (by plotting on graph paper) and wound quality (by modified wound infection checklist score and swabs for culture and Gram staining) were assessed before and after TOT application. Results: The study cohort included 20 patients ≥18 years of age. There was a statistically significant (p<0.001) reduction in mean wound surface area from 79.3cm2 at baseline to 69.6cm2 after two cycles of TOT. The mean modified wound infection checklist score was 13.6 and 0.8, respectively, before and after two cycles of TOT, suggesting statistically significant improvement (p=0.02) in wound quality. All patients showed no growth in their wound culture after TOT. Conclusion: TOT appears to be a promising and cost-effective alternative in the management of traumatic wounds. However, future studies with larger sample sizes and control groups for comparison are needed to establish the benefit of TOT in acute traumatic musculoskeletal wounds. [ABSTRACT FROM AUTHOR]

In 2002, the Department of Health (DH) introduced an information strategy that was intended to improve care, reduce duplication and increase patients' involvement in their own records and management of care. Student midwives are educated to appreciate that good record keeping and documentation is integral to safe, effective midwifery practice. As electronic health records (EHRs) become more widespread, this survey aimed to investigate midwifery students' experiences of electronic health records (EHR) in practice, using questionnaires and focus groups. The questionnaire results indicated the types of EHRs students had accessed and used. From the focus group, three themes emerged: benefits of EHRs for care delivery; practical issues of EHRs and accountability; incongruence between EHRs and the concept of 'normality' in childbirth. As student midwives increasingly encounter EHRs in their practice, education and health providers should collaborate to implement appropriate training and preparation. [ABSTRACT FROM AUTHOR]

Background: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. Aim: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. Method: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. Findings: Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. Conclusion: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops. [ABSTRACT FROM AUTHOR]

This paper sought to investigate non-medical prescribers' awareness of compliance and what is required for them to be compliant when prescribing in an acute NHS trust. This was a quantitative pilot study using a survey technique with an online questionnaire. A purposive sample from 85 registered non-medical prescribers who were actively prescribing were invited to participate. Data analysis was restricted because of the limited number of respondents (n=14), making this a pilot study. Data were analysed using descriptive statistical analysis IBM SPSS 25 software. The majority (85.7%) of non-medical prescribers were shown to be compliant, highlighting 14.3% as non-compliant. Furthermore, 28% prescribed outside of their personal formulary, which is in breach of the non-medical prescribers' trust policy. A further 85% participated in continuous professional development and 72% requested regular continuous professional development. Despite the majority being compliant with the non-medical prescribers' policy, 14.3% were not. This clearly has implications for patient safety and practitioner professionalism, in terms of responsibility and accountability. Although limited by small respondent size, the findings highlight the need for further research to inform recommendations for practice. [ABSTRACT FROM AUTHOR]

This paper presents the findings from an analysis of survey data which was collected from public health nurses (N = 136) as part of a larger study with more than 4000 nurses and midwives in Ireland. The purpose of the study was to examine the prevalence of burnout using the Oldenburg Burnout Inventory and to compare relationships between burnout, demographic and work characteristics across this group of nurses. Younger PHNs were most likely to report feeling burnout (68%) compared with those aged 51 or over (47%) who reported the lowest levels. PHNs whose highest level of qualification was a primary degree were least likely to report feeling burnout (31%) compared with those who held a Masters / Doctoral degree (54.5%). PHNs who reported working on a fixed-term full-time contract were most likely to report feeling burnout (70%) compared with those who were on a permanent part-time contract (49%). Quantitative analysis, using both descriptive and inferential statistics, was carried out and the findings show that PHNs reported moderate levels of burnout. The findings also show that burnout among PHNs is strongly correlated with the physical demands placed on individuals during work, having constant time pressures, too much being expected of individuals, the work environment being too demanding and dissatisfaction with the physical conditions. [ABSTRACT FROM AUTHOR]

Objective: After launching the 2019 International Pressure Ulcer/Injury Guideline, the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) collaborated with Sensorydata Corp., US, to develop a guideline app (InterPIP App). The app was designed to: present evidence-based guideline recommendations; incorporate search capacities and functionality to facilitate easy access to clinical guidance; provide accessibility in multiple languages; and to be available worldwide at a reasonable price, including opportunities for free access in low-resource countries. This paper describes the development, dissemination and formative evaluation of a mobile app providing evidence-based recommendations for pressure injury prevention, assessment/classification, and treatment at the point of care. Method: An evaluation tool was designed based on a framework developed by Nouri et al. and made available to all app subscribers. Results: The InterPIP App is currently available in 11 languages and had been downloaded 3616 times by February 2022 in 78 countries. A total of 62 individuals responded to the survey of end-users. In this formal evaluation of user experiences, the app was rated positively on criteria of: information/content; usability; design; functionality; ethics; and security/privacy (median=4 on a 1–5 Likert scale). Overall perceived value was ranked lower with a median of three. Users provided suggestions for ongoing app enhancement. Conclusion: The InterPIP App offers a unique opportunity to bring evidence-based guidance to the point of care. Formal evaluation of end-user experiences identified opportunities for quality improvement, and informed plans for future development and evaluation. [ABSTRACT FROM AUTHOR]

Objective: This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration. Method: We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic. Results: A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11–43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14–62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%. Conclusion: Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented. [ABSTRACT FROM AUTHOR]

Background: Nursing students often face anxiety and cognitive overload, leading to high attrition rates; meanwhile, traditional pastoral interventions have proved insufficient. A novel, digitally enhanced learning environment named The Wellbeing in Student Education (WISE) Room, was introduced as an alternative at a UK university. Aims: This study investigated the impact of The WISE Room, a 4m × 4m digital platform containing touch-interactive walls, co-created with students and academic staff, designed to promote insight through immersive experiences beyond traditional learning settings. Methods: A mixed-methods approach was adopted, collecting data from nursing students, healthcare staff and academic faculty. Data were collected at three stages, each corresponding with the iterative development of The WISE Room, including an evaluation of the intervention. Results: Feedback from 240 participants was positive. In Phase 2 of the study, 93% of the 79 students and 21 staff who visited the room and completed a survey were satisfied with the room's suitability in three key areas: emotional wellbeing, academic readiness, and placement preparedness. Conclusion: The WISE Room has proved effective in supporting nursing students' wellbeing, and educational and placement preparation requirements. Its multisensory, digital and experiential nature is beneficial for students throughout their learner journey. Additional trials and content development will be required to enhance the learning and teaching experience further. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. Method: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. Results: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. Conclusion: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures. [ABSTRACT FROM AUTHOR]

The article presents Chapter Four of a paper on the use of eHealth applications on wound care which is a review of literature. Topics include the review's aim of evidence evaluation of telemedicine, the search of clinical studies of telemedical intervention for chronic wound care, and the consideration of parameters such as geographical location, year of publication, and type of wound. It presents a table of the studies included in the paper.

* Objective: To evaluate the effect of topical haemoglobin spray on treatment response and wound- closure rates in patients with chronic venous leg ulcers. * Method: A linear regression model was used to forecast healing outcomes over a 12-month period. Simulated data were taken from normal distributions based on post-hoc analysis of a 72-patient study in non-healing and worsening wounds (36 patients receiving standard care and 36 receiving standard care plus topical haemoglobin spray). Using a simulated 25,000 'patients' from each group, the proportion of wound closure over time was projected. * Results: Simulation results predicted a 55% wound closure rate at six months in the haemoglobin group, compared with 4% in the standard care group. Over a 12-month simulation period, a 43% overall reduction in wound burden was predicted. With the haemoglobin spray, 85% of wounds were expected to heal in 12 months, compared with I 3% in the standard care group. * Conclusion: Topical haemoglobin spray promises a more effective treatment for chronic venous leg ulcers than standard care alone in wounds that are non-healing or worsening. Further research is required to validate these predictions and to identify achievable outcomes in other chronic wound types. * Declaration of interest: The treatment response data for this paper was kindly provided by the Department of Dermatology, Charles University School of Medicine, Prague, Czech Republic. K Cutting is a consultant to infirst HEALTHCARE Ltd. This paper was supported by a research grant from infirst HEALTHCARE Ltd, a licensee of Granulox haemoglobin spray. [ABSTRACT FROM AUTHOR]

Background/aim: Widowhood in later life is a transition experienced by many older people, particularly older women. This paper explores the challenges encountered by a group of older women experiencing the loss of a spouse or partner. Methods: The data is drawn from a longitudinal study exploring the significance of personal communities in managing the transition of later life widowhood. A series of qualitative interviews were conducted with 26 older widows (62-90 years of age) over a period of 18 months. Interview transcripts were subjected to thematic analysis. Results: This paper presents a number of themes from the women's accounts of their Christmas celebrations and their Christmas cards, which illustrate the challenges to managing widowhood in later life. Themes included: family friction, dependence, additional losses, over commitment, passivity and feeling different. Conclusion: The findings reveal that Christmas can be an isolating and excluding experience for some older women, and that widowhood can be compounded by age-related illness, and the loss of social relationships and roles in later life. The research has a number of implications for practice with older women who are widows. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU. Method: A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool. Results: The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47–88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76μg/min, 95% CI: 6.06–11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10–15.82; p<0.00001). The overall validities of the studies varied between 45–90%, meaning that there is potential for bias within all the included studies. Conclusion: Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper. [ABSTRACT FROM AUTHOR]

Aims: Skin breakdown is common in the intensive care unit (ICU). This pilot evaluation aimed to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complications of blistering and other skin breakdowns in a high-risk ICU population with Foley catheters. Design: A prospective, non-randomised performance improvement study using a convenience sample was carried out. Subjects and setting: The study sample consisted of 29 patients with urethral Foley catheters and any degree of thigh oedema in a surgical ICU at an academic quarternary medical center. Methods: Patients were fitted with a standard acrylic-adhesive catheter securement device on one thigh and a nurse-constructed device on the contralateral thigh. At the beginning of each 12-hour shift, the nurse moved the Foley catheter from one securement device to the other; the nurse recorded the assessment findings at the end of the shift. Results: The average age of the 29 patients was 61±16 (range 20–87) years. Visible skin compromise occurred in 21% of the time with the standard acrylic securement device; an equal percentage of men and women developed skin breakdown. Oedema status was a significant factor related to skin breakdown. There was no visible damage to the skin associated with the nurse-constructed silicone-adhesive device. Conclusions: A silicone adhesive urinary catheter securement device causes less skin damage than one with acrylic adhesive. One-step application, pain-free and atraumatic removal, and reliable securement are essential considerations in product development. [ABSTRACT FROM AUTHOR]

Background/Aims: Anaemia is a multifactorial condition and understanding its prevalence and associated factors is crucial for effective healthcare planning and interventions. The aim of this study was to explore the prevalence of anaemia during pregnancy and its potential risk factors in Oman. Methods: A retrospective approach was used to identify anaemia cases by examining medical records taken from 9321 women who gave birth at the hospital over 3 years. Chi-squared tests were used to establish differences in risk factors using a case-control design, with a 1:2 ratio. Results: The crude prevalence of anaemia was 31.2%, dropping to 4.9% after excluding women with chronic and/or acute diseases. Significant differences were found in nationality (χ2=4.738, P=0.030), body mass index (χ2=6.392, P=0.041) and gestational age (χ2=4.329, P=0.037) for women with anaemia compared to those without. Conclusions: These findings underscore the significance of assessing and managing anaemia in pregnancy, while considering the interaction of demographic and clinical variables in formulating anaemia prevention strategies. [ABSTRACT FROM AUTHOR]

Hospital sound has been well documented through acoustic measurement and the classification of its adverse effects on patients and nurses. However, little consideration has been given to how the perception of these unavoidable soundscapes can be improved. For instance, does a better understanding of the variety of sounds improve patients' feeling? This paper begins to answer this and documents a pilot questionnaire-based study looking at the effects and potential benefits of sound source information (SSI) on patients' subjective reactions to a ward soundscape. The study was carried out from July to September 2011 with 31 patients in a cardiothoracic ward. Although strong inferences were not made, it was found that this simple intervention created a 21-26% positive change perception (p≤0.05). The paper discusses the results in relation to nursing practice, concluding that SSI could be beneficial in helping patients to feel more comfortable. [ABSTRACT FROM AUTHOR]

Objective: To investigate the hypothesis that stereophotogrammetric wound size monitoring shows suitable inter-observer reliability and user acceptance for clinical practice use. Method: Veterans admitted for conservative management of severe pressure ulcers were eligible for inclusion in the study. Three-dimensional (3D) digital wound images were independently captured by two expert and two non-expert nurse-observers using a commercially available stereophotogrammetry system, weekly for 6 weeks. A double-blinded analyst generated 3D wound reconstructions, using software to determine geometry. Clinical opinion of wound progression was provided by an expert physician. Results: Thirteen wounds were assessed with more than 80% of all images being readable. Interclass correlation of 0.9867 (p < 0.0001) was observed. Compared with clinical opinion, 3D wound measurement was sensitive between improving and static wounds for wound perimeter, volume, depth and length. Conclusion: These preliminary findings suggest that 3D wound measurement minimises differences in wound measurement between expert and non-expert observers, suggesting it could be implemented with high reliability in health-care settings where several observers are involved in wound care management. Declaration of interest: This study was funded in part by a grant from the Department of Veterans Affairs VISN10 Research Initiative Program. All study personnel contributed to the paper. AJD's effort was provided in partial fulfilment of the requirements for the MD degree from Case Western Reserve University School of Medicine. The authors declare they have no conflict of interests with regard to the information presented in this paper. [ABSTRACT FROM AUTHOR]

To allay public apprehension regarding the risk of nurses' uniforms transmitting healthcare-associated infections (HCAI), national and local guidelines have been issued to control use, laundry and storage. This paper aims to measure the knowledge of registered nurses (RNs) and healthcare assistants (HCAs) working within a rural NHS foundation Trust and their adherence to the local infection prevention and control (IPC) standard regarding uniforms through a Trust-wide audit. Stratified random sampling selected 597 nursing staff and 399 responded (67%) by completing a short questionnaire based on the local standard. Responses were coded and transferred to SPSS (v. 17) for analysis. The audit found that nursing staff generally adhere to the guidelines, changing their uniforms daily and immediately upon accidental soiling, and wearing plastic aprons where indicated. At home, staff normally machine-wash and then iron their uniforms at the hottest setting. Nevertheless, few observe the local direction to place their newly-laundered uniforms in protective covers. This paper recommends a re-audit to compare compliance rates with baseline figures and further research into the reasons why compliance is lacking to sanction interventions for improvement, such as providing relevant staff education and re-introducing appropriate changing facilities. [ABSTRACT FROM AUTHOR]

Background: The Medical Emergencies in Eating Disorders (MEED) report was first released by the Royal College of Psychiatrists in 2022 (updated 2023) to aid clinicians in recognising medical compromise due to an eating disorder and to provide guidance for management. Aims: This study looked at admissions over 5 years to explore whether there is a correlation between MEED medical compromise parameters and three outcomes: length of stay, detainment under the Mental Health Act 1983, and discharge destination. Methods: A retrospective study of 26 patients admitted to a large teaching hospital for an eating disorder between 2018 and 2023. The risk assessment from the MEED report was used to create a score for physical compromise and analysed to determine whether there was a correlation between the score and discharge destination, detainment under the Mental Health Act and length of stay. Findings: Demographic data were comparable with larger studies, with increasing numbers and 19.2% having autism spectrum disorder. There was no correlation between the scoring tool and detainment under the Act, discharge destination or length of stay. Conclusion: Increasing numbers of patients are presenting with eating disorders. Physical compromise was not a predictor for admission outcomes, but this could be further explored in larger studies. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to explore the incidence of impostor phenomenon among 79 nurses in specialist roles in a single NHS trust in England, using an online anonymous questionnaire that included the Clance Imposter Phenomenon Scale and free-text responses. Results indicated a high prevalence of impostor phenomenon, with no specific variables predicting its occurrence. Four main themes emerged: self-doubt, role expectations, fear of exposure as an impostor, and factors leading to burnout. The study highlights the need for targeted support and training for this cohort, particularly as impostor phenomenon was found to be prevalent during career transitions and was not limited by gender. The findings have implications for nursing management and education, offering the opportunity to develop specific support mechanisms to alleviate impostor phenomenon and potentially reduce attrition rates in specialist nursing roles. [ABSTRACT FROM AUTHOR]

Midwives do not routinely receive training in how to manage parent care when Down syndrome (DS) is identified in pregnancy or after birth. Many parents report dissatisfaction with the response of health professionals during this time. In response to this, the UK Down's Syndrome Association has developed the Tell it Right, Start it Right training. This paper reports on an evaluation of the training using the Kirkpatrick model (Kirkpatrick and Kirkpatrick, 2006). A repeated measures online survey was delivered before training, immediately afte training and 2 months after training. Midwives constituted the majority of participants. The evaluation found that knowledge of DS, confidence in communicating with parents and confidence in delivering a diagnosis of DS significantly increased after attending. Some evidence of applying knowledge in the workplace was identified; however, such training must become embedded in mandatory professional education if widespread improvements in parent experience are to be achieved. [ABSTRACT FROM AUTHOR]

* Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure between the skin and the support surface. The comparative effectiveness of dynamic support surfaces is debated. The aim of this study is to examine the impact of using an alternating pressure air mattress (APAM) on pressure ulcer (PU) incidence in patients receiving home-based care. A second aim was to determine the level of patient/ family satisfaction with comfort and gain the views of the care team that used the APAM. *Method: The PARESTRY study was a prospective observational study conducted in patients with a high risk of PUs (Braden score <15), discharged to hospital-care at home. The primary prevention groups consisted of patients with no PU at baseline who were in bed for at least 20 hours a day. Patients at baseline with a category 3 or 4 PU or a category 1 or 2 PU in association with poor general health or end-of-life status were included in the secondary prevention group. All patients were laid on an APAM. The primary end point was the % of patients with a worsening skin condition in the pressure area (heel, sacrum, ischium) at day 90 or at the end of the study. The primary analysis was done on the full analysis set (patients included with at least a second assessment), using the last observation carried forward technique to handle missing data, at day 90. A 95% confidence interval was calculated. *Results: Analysis was performed on 92 patients (30 in primary prevention and 62 in secondary prevention). The average time spent in bed was 22.7 (SD 2.7) hours a day and 22.6 (SD 2.2) hours in the primary and secondary prevention groups, respectively. At baseline, in the secondary group, 77% of patients had a sacral PU, 63% a heel PU, 8% an ischial tuberosity PU and 45% a PU in another area, a number of patients having multiple PUs. In the primary prevention group, 63% (19/30) of patients dropped out of the study (5 were hospitalised, 9 died, 5 other causes). In the secondary prevention group, 61% (38/62) dropped out (7 were hospitalised, 23 died, 8 others causes). In the primary prevention group, only one patient had worsening skin condition. In the secondary prevention group, 17.7% (11/62: 95% CI: 8.3-27.2) of patients had worsening skin condition. The number of PUs decreased regardless of location. At the end of follow-up, 49% (45/92) of patients had a PU versus 67% (62/92) at baseline *Conclusion: This work provides data on the incidence of PUs in patients at high risk, who are using APAMs, and, following inpatient hospitalisation, are taken into home health-care centres. The results of the study highlight the importance of continuity of care across transitions between care settings. *Declaration of interest: SM has served on advisory board to Medidev-Sentech, Lyon (sponsor) and received fees from Sentech. MM (as member of Nukleus) served as advisory board to Medidev-Sentech (Sponsor) and received fees from Medidev-Sentech. This study and writing of paper was funded by Medidev- Sentech, which is the distributor for France for the Sentry 1200 mattress. Medidev-Sentech played no active part in the design, data management, analysis and reporting of the study. Nukleus (Paris) achieved setting and monitoring. Data management and statistical analysis were performed by Cenbiotech (Dijon). [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]

Objective: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. Method: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. Results: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (–0.391, p=0.025; –0.435, p=0.013, respectively), and pigmentation scores at three and six months (–0.391, p=0.019; –0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (–0.6609, p=0.000; –0.348, p=0.046, respectively). Conclusion: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts. [ABSTRACT FROM AUTHOR]

Background/Aims: Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women. Methods: In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed. Results: A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women. Conclusions: To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome. [ABSTRACT FROM AUTHOR]

Randomised controlled trial (RCT) literature plays a fundamental role in informing evidence-based medicine and nursing. This paper aims to track geographical and temporal trends in the publication o f RCTs in nursing over the past 20 years by means o f a bibliometric analysis. The PubMed database was searched for articles published from 1 January 1991 to 31 October 2011 and satisfying this search strategy: nursing [MeSH Terms] AND (RCT OR trial* OR ‘experimental study’ OR randomised OR randomisation) AND (English[lang]). Abstracts were reviewed to assess whether they met the criteria for an RCT. A manual search of information on country o f origin was carried out and Journal Citation Reports® was used to allocate journals to subject areas. RCT methodology is increasingly drawing the attention o f nursing researchers worldwide. However, there is a large disparity in research productivity, at least in terms o f number o f published RCTs in the English language and listed on PubMed, between the most productive continents, North America and Europe, and the others. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the sleeping position of infants attending an outpatient clinic, considering the influences of the back to sleep (BTS) campaign. A paper survey was given to 678 parents who presented their infant (under 1 year of age) to the paediatric chiropractic clinic for care asking their infant’s sleep position. Of the total survey sample, 50% of parents selected the supine position as the preferred position they placed the baby to sleep, 19% of parents preferred to place their babies prone, 34% on the babies side and 2% selected other. Some mothers selected more than one preferred sleeping position. The initial decline of mothers using non-supine positioning, seen shortly after the implementation of the BTS campaign, is no longer evident. Recent research implies approximately half of infants are now placed in a non-compliant sleeping position. If an infant’s most preferred sleeping position is not that of current guidelines, manual therapy such as chiropractic care should be sought to help infants sleep supine with comfort. [ABSTRACT FROM AUTHOR]

This paper evaluates the pain management provided to patients following surgery for colorectal cancer. These patients were part of an enhanced recovery after surgery (ERAS) programme, which among other goals, aims to reduce length of hospital stay. The aim of the service evaluation was to investigate the success of the pain service in meeting the needs of the patients in relation to provision of analgesia for their postoperative recovery, ensuring that the ERAS programme wasn't compromising patient satisfaction. Findings demonstrate high levels of satisfaction with pain management and the approach of staff. The study also reinforces findings that there is a paradoxical link between pain intensity and patient satisfaction. However, despite advances in care, treatments and services, patients continue to experience high levels of pain after surgery and recommendations are made on how pain management services provided to patients after surgery might be enhanced. [ABSTRACT FROM AUTHOR]

Considering the emphasis on safety in health care, new methods for training qualified nurses are being considered. The use of simulation technologies to provide regular and repeated training for qualified nurses in the management of paediatric emergencies has yet to be investigated. This paper presents the results of a study designed to determine if and how a period of regular simulation training in the management of paediatric emergencies improves qualified nurses' clinical confidence. A mixed methods design was employed using a group of qualified paediatric nurses (n=20) who were matched into two groups. The intervention group (n=10) received three simulation-based training sessions and the control group (n=10) had no training. Each nurse completed a pre- and post-clinical confidence questionnaire and were interviewed. Results demonstrated a statistically significant improvement in confidence following simulation training, which was explained by the provision of insight and preparation for real life. Further research should aim to replicate these findings using larger sample sizes and direct assessments of nurses' clinical performance. [ABSTRACT FROM AUTHOR]

Aims This paper examines: the intra-rater, inter-rater and test-retest reliability of the Five-Times-Sit- To-Stand (FTST5) test administered by experienced and inexperienced assessors; and the correlation of FTSTS test times with lower limb muscle strength and balance performance in healthy older and young people. Method The cross-sectional study investigated reliability using test batteries including: FTSTS times; hand-held dynamometer measurements of hip flexor, knee flexor and extensor, and ankle dorsiflexor and plantarflexor muscle strength; Berg Balance Scale (BBS) scores; and dynamic posturography measurements of the limits of stability (LOS). A convenience sample of 12 healthy older and 12 younger participants was recruited in the local university-based rehabilitation centre. Results The FTSTS test showed excellent intra-rater reliability (intraclass correlation coefficient (ICC) range: 0.914-0.933) and moderate intra-rater reliability (ICC range: 0.644-0.879) in healthy older and young subject groups respectively. Inter-rater reliability between assessors yielded an ICC of 0.990. Test- retest reliability (ICC range: 0.988-0.995) was excellent. FTSTS times were not significantly associated with the older subjects' lower limb muscle strength, BBS scores or LOS results. Conclusion The FTSTS has good intra-rater, inter-rater and test-retest reliability. There is no significant correlation of FTSTS times with lower limb muscle strength or balance performance in healthy older people. The FTSTS test is a reliable measurement tool whether used by experienced or inexperienced assessors. A future study with a larger sample size is required for establishing the validity of FTSTS test times in the older population. [ABSTRACT FROM AUTHOR]

This paper describes the development of a tool for palliative care nurses to initiate and facilitate advance care planning (ACP) conversations in community palliative care practice. Seven community palliative care services located across Australia participated in a multi-site action research project. Data included participant observation, individual and focus group interviews with palliative care health professionals, and medical record audit. A directed content analysis used a pre-established palliative care practice framework of referral, admission, ongoing management, and terminal/discharge care. From this framework a Conversation Starter Tool for ACP was developed.The Tool was then used in orientation and continuing nurse education programmes. It provided palliative care nurses the opportunity to introduce and progress ACP conversations. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is an incurable, progressive neurodegenerative disorder that gradually results in accumulating disability. Evidence suggests that specific interventions, for example, physical exercise and movement strategy training, can improve some of the PD-associated problems and enhance quality of life. The aim of this paper is to demonstrate the effect of a tailored rehabilitation programme, comprising of a combination of exercise therapy and movement strategy training, on falls risk, mobility, and quality of life in people with PD. Methods: A prospective longitudinal design, with 1- and 2-year follow-up, was conducted, where fifteen people with idiopathic PD and average age of 76.1 years attended weekly, then biweekly 90-minute rehabilitation sessions that focused on exercise therapy and movement strategy training. Outcome measures were assessed at baseline and at 1- and 2-year, which included self-reported number of falls, Freezing of Gait Questionnaire, Tinetti falls assessment tool, and Parkinson's Disease Questionnaire (PDQ-39). Results: At 1-year, a significant improvement was identified in gait freezing and Tinetti scores, as well as a statistically significant reduction in the number of falls and falls risk. Several aspects of the PDQ-39 have also improved. Some of the effects continued to exist through year two, but the improvement has not been consistent compared to year one. Conclusion: A combination of regular exercise and movement strategy training has the potential for reducing falls risk, and improving mobility (less gait freezing) and quality of life of people with PD. [ABSTRACT FROM AUTHOR]

Background/Aims: Mouth opening is a routine and vital activity of daily life that facilitates ingestion and speech. It is often found to be limited in patients with oral carcinoma. Measuring mouth opening is essential to detect the therapeutic effect of an intervention aiming to improve it. During measurement, the procedure needs to be reliable, simple, inexpensive and safe. This study aimed to determine the intrarater and interrater reliability of a novel method of measuring maximal voluntary mouth opening in patients with oral carcinoma. Methods: Patients aged between 40 and 60 years of either gender with a diagnosis of oral carcinoma and presenting with difficulty in mouth opening were recruited. The distance between incisors was marked on standard sized paper slips as the participants performed maximal voluntary mouth opening. Distance between the markings was measured with a ruler in millimeters. The measurement procedures were carried out by two independent investigators. Results: A total of 15 patients (12 male and 3 female) with a mean age of 52.53 ± 8.28 years participated in the study. Mean maximal voluntary mouth opening measure was <35 mm, indicating restricted mouth opening in these patients. Intrarater reliability of 0.95 (0.87–0.98) and interrater reliability of 0.96 (0.89–0.98) were found for the measurements. Conclusions: The reliability of maximal voluntary mouth opening measurement using this novel technique was found to be excellent. This technique can be used in the routine clinical evaluation of patients with oral carcinoma. [ABSTRACT FROM AUTHOR]

Objective: To identify the incidence of category II or higher hospitalacquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. Method: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. Results: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806--0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183--2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010--1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006--1.019) and diaper (HR: 1.007; 95% CI 1.001--1.013) in the postoperative period. Conclusion: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Objective: Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. Methods: A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. Results: There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). Conclusion: Attempted suicide by self-inflicted burns represents <1% of burn admissions. This population demonstrates a high incidence of prior psychiatric disorders. Successful treatment includes multidisciplinary management of acute medical, surgical, and psychiatric care. [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]

Rowan Clemente, Specialised Dietitian, and Stephen Taylor, Research Dietitian, North Bristol NHS Trust, consider the current UK pH stick threshold and whether it might be putting vulnerable patients at risk [ABSTRACT FROM AUTHOR]

Background/Aims Antenatal care is important for screening, monitoring and management of pregnancy risks. This study analysed determinants of antenatal care in Indonesia among women aged 18-24 years and older than 30 years, who are at greater risk of pregnancy and birth complications. Methods This cross-sectional study used secondary data from 4338 women in the 2017 Indonesian demographic health survey. Chi-square tests and binary logistic regression were used to explore the effects of individual, partner and social factors on antenatal care. Results Antenatal care attendance was associated with a younger age at first birth (adjusted odds ratio: 1.49; P<0.001), health insurance (adjusted odds ratio: 1.54; P=0.004) and the middle wealth quintile (adjusted odds ratio: 1.78; P=0.002). Conclusions Collaboration is needed to increase awareness of complications and the importance of antenatal care. [ABSTRACT FROM AUTHOR]

Background/Aims: Women worldwide experience post-childbirth morbidities such as incontinence and pain. While there is limited evidence of women's help-seeking behaviour, many do not seek treatment. This study aimed to explore the key influences on women's help-seeking behaviour 12 months after birth. Methods: Three different study approaches were used: a meta-aggregation systematic review, concept mapping and a directed qualitative content approach. Results: Women often did not seek help because they accepted problems as a normal part of motherhood. They were more likely to share problems with family and friends. Online platforms allowed women to share their problems anonymously, but the support provided demonstrated some normalising of abnormal problems. Conclusions: The feminist pragmatic approach highlighted the 'fallacy of normalcy' as underpinning women's help-seeking behaviour after childbirth. [ABSTRACT FROM AUTHOR]

Background: Little is known about community nurses' knowledge of breathlessness and its management in chronic obstructive pulmonary disease (COPD). Aim: To explore the community registered nurses' knowledge of COPD and the strategies that they use to manage breathlessness in people with COPD. Methods: A cross-sectional survey study of community registered nurses was conducted using the 65-item Bristol COPD Knowledge Questionnaire and an open-ended item to outline breathlessness strategies. Findings: A total of 59 nurses participated. The total mean Bristol COPD Knowledge Questionnaire Score was 43. The breathlessness category was the lowest scoring category. There were three themes that synthesised: the community nurse's role in monitoring self-management of medications to relieve breathlessness; the use of non-pharmacological strategies to relieve breathlessness; the nursing skills used to monitor breathlessness in people with COPD. [ABSTRACT FROM AUTHOR]

Background: Recent international documents have highlighted the importance of preparing the nursing workforce for end of life care. However, these documents do not make clear what prepared in the context of end-of-life care actually means. Searching the literature failed to retrieve any papers defining prepared in this context. Aim: A concept analysis, using Walker and Avant's model, was conducted to help address this gap in the knowledge base. Results: From this analysis many attributes and antecedents were synthesised. These include that a prepared nurse would be confident to: assess the dying patient, communicate with empathy, identify and manage symptoms, recognise and deal with death and dying, understand the holistic elements of dying, be comfortable with the effects of loss and bereavement on patients and self, and be self-competent. Conclusions: From this analysis, a clearer idea of what is needed to prepare nurses for end-of-life care is offered and suggestions for future research are made. [ABSTRACT FROM AUTHOR]