Search

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]

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]

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]

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 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]

Background/Aims: The inclusion of blended e-learning approaches to teaching has become more prevalent in higher education. The purpose of this paper was to examine sports therapy students' experiences of using an online learning channel designed to assist practical skills. Moreover, creating an understanding of students' adoption of the learning channel to determine its efficacy. Methods: The design was a qualitative exploratory study in which a questionnaire was designed to investigate students' experience of using the learning channel across all undergraduate BSc Sports Therapy modules. One-hundred and sixty-four (level four: n=67; level fve: n=51; level six: n=46) students completed the questionnaire relating to their experience of an online video-based learning channel. Findings: BSc Sports Therapy students across all levels found the learning channel useful, with the most common responses related to revision and consolidation of practical skills. Exam preparation was associated to this suggesting students' beliefs were driven by resources which could facilitate grade improvement in practical exams. Conclusions: The sports therapy learning channel was received very positively, with both the visual and practical nature of online instructional videos deemed important. [ABSTRACT FROM AUTHOR]

In the UK there has been a widespread introduction of 'anticipatory prescribing' in community based palliative care. This involves general practitioners (GPs) writing prescriptions in anticipation of them being needed and has been encouraged to try to minimise the risk of patients suffering uncontrolled symptoms and distress; a key reason why terminally ill patients are admitted to hospital in contradiction of most people's preferences. This paper presents the findings from an ethnographic study of healthcare professionals across four care homes and four community sites in two regions (East Midlands and Lancashire/South Cumbria) of the UK. Data were collected from a range of community health professionals, resulting in 83 episodes of observation and 72 interviews. Findings highlight how essential good interdisciplinary communication is to the process of anticipatory prescribing and end-of-life care. This study found that when interdisciplinary communication worked well the anticipatory prescribing process could be carried out smoothly, optimising patient care. [ABSTRACT FROM AUTHOR]

Aims and background: This analysis paper describes a comparative evaluation of service deliverables within the Service Level Agreements (SLA) of two acute psychiatric services, one inclusive and the other exclusive of occupational therapy. Methods: Six SLA agreements provided the standards by which the two services were evaluated. The SLAs were evaluated because they are used by the service managers and commissioners to measure performance and clinical effectiveness. The role of the occupational therapists and their contribution to the planning and delivery of the performance indicators was also considered. An evaluation framework was applied to explore the potential role occupational therapy may have had in any performance difference between the two sites. In doing so it is hoped to provide some evidence to support and inform occupational therapists and service managers on the role and of occupational therapy in acute mental health services. This comparative evaluation followed the first three of the five audit stages: 1. Preparing for audit; 2. Selecting criteria; and 3. Measuring performance level. Findings: The service with occupational therapy performed better on home leave day use, ward occupancy and less than 3-day admissions. Conclusions: By delivering their key roles of individual assessment, therapeutic groups, individual treatment and discharge planning, occupational therapists were able to contribute to the overall efficiency of service delivery. These findings support the role of the occupational therapist in an acute psychiatric setting and provide guidance for managers on how to utilise occupational therapy in the delivery of service outcomes. [ABSTRACT FROM AUTHOR]

Aim: To gain a greater understanding of the methods used by podiatric surgeons to access medicines in the UK. Within that, it is also relevant to establish the range and quantity of medicines utilised to support patient care. With the advent of independent prescribing for podiatrists, the authors were keen to identify whether prescribing was being adopted by a sub-speciality of the podiatry profession and whether alternate means of accessing medicines, such as Patient Group Directions or exemptions remain relevant in clinical practice. Methods: The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; procedures, fixations, anaesthesia, demographics, medications, post-treatment sequelae, patient satisfaction (PSQ-10), Manchester Oxford foot/ankle questionnaire (MOXFQ), providers and referrals. Results: In 2019 there were 11189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. A total of 103 surgery centres contributed data resulting in 18497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18576 medicines were supplied, administered or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs accounted for 28.7% of all recorded medicines. Conclusions: Through analysis of PASCOM 10 data, the range of medicines accessed by podiatric surgeons and their teams to support patient care perioperatively and the routes of accessing these medicines have been identified. Encouragingly, independent prescribing appears to be a frequent choice for accessing certain medicines. There is thorough evidence of a need for greater prescribing rights. Of note, it appears the management of postoperative pain could be improved with wider access to controlled drugs, namely opioid analgesics. PASCOM-10 has the capacity to provide revealing data on prescribing in podiatric clinical practice that is unique in the UK, though more work is required to ensure the validity of the dataset. [ABSTRACT FROM AUTHOR]

Background: During the first wave of the COVID-19 pandemic in the UK, south London had the highest number of COVID-19 patients admitted to critical care. At one hospital, staff being redeployed to critical care were invited to attend an orientation to critical care workshop. Aim: To carry out a service evaluation of the training outcomes from rapidly redeployed staff who completed the workshop during the first wave of the COVID-19 pandemic (March–July 2020). Methods: Two stages were used, the first was a post-workshop evaluation questionnaire completed immediately after the training, with the second involving a single centre e-survey questionnaire two months later. Findings: In total 131 health professionals attended the workshop, and 124 (95%) postcourse evaluations were completed. Some 116 staff were contacted for the e-survey, with a response rate of 34% (n=40). Overall, the training was well evaluated. Of the 40 respondents, 70% (n=28) had volunteered, but only just over half (n=21, 52%) went on to work in critical care. Conclusion: This article describes the organisational response of one NHS acute hospital to the unprecedented challenges that arose from the COVID-19 pandemic. The service evaluation identified the importance of a pedagogical approach, which not only delivered clinical content, but also allayed anxiety for health professionals preparing to work in a new environment. [ABSTRACT FROM AUTHOR]

Nursing is one of the most trusted professions, yet it is poorly defined. There are many definitions and characterisations of nursing. This study sought to pilot a survey exploring the views of nursing in the 21st century. Methods: This study piloted an electronic survey with open and closed questions. Descriptive statistics were collated for closed questions using Excel. Open-ended questions were analysed using the text analysis program Linguistic Inquiry and Word Count (LIWC) for tone, emotion and criticality. Results: This pilot study recruited 72 participants from professional and non-professional backgrounds. Respondents displayed diversity in their perceptions of nursing, the role of nurses and the role that nurses perform. Conclusion: Nursing is a complex, multifaceted profession. The view of nursing was generally positive and authentic although not easy to define. Nursing was felt to be an inclusive profession; however, it is extremely diverse in nature. Further research is required to explore these concepts in greater depth. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the acceptance of the midwives regarding the use of newborn pulse oximetry screening (NPOS) over a four-year period in a UK tertiary maternity unit. Methods: An electronic survey of 10 questions was emailed to all midwives working in the maternity unit. Feedback was requested on their experience of performing NPOS using a feasibility scale (1=easy to 10=difficult). Other qualitative feedback explored the perceived usefulness and recollection of positive screening outcomes. The collated feedback was analysed using Wilcoxon Signed Rank test. Results: Complete responses were received from 99 of 236 (42%) midwives. The average scale rankings of 3.46 (pre-introduction) and 2.38 (post-introduction) indicates that the responding midwives were positive about NPOS (z=-4.5575; p<0.001) and 99% (n=98) felt it was an important screening tool. Of the midwives, 38 (39%) had at least one positive screening result. Conditions identified included cardiac anomalies, sepsis and diaphragmatic hernia. Conclusion: Our single-centre survey suggests that the NPOS has been well accepted by the midwifery staff in this maternity unit. [ABSTRACT FROM AUTHOR]

Aim: To analyse how midwives communicate Down syndrome screening information and explore whether women's understanding of this information is influenced by midwives' communicative style. Methods: Midwives (n=16) and women (n=100) were recruited from a regional NHS unit in the UK. A mixed-methods design encompassed two components; audio-recorded antenatal consultations to assess midwives' communication and quantitative surveys to assess women's understanding. Findings: Midwife communication was not significantly related to women's understanding of Down syndrome screening information. However, qualitative thematic analysis revealed midwife communication was often insufficient in fully describing Down syndrome and screening. Communication was not very interactive, midwives dominated conversations and did not sufficiently check women's knowledge/understanding. Conclusions: Policymakers need to consider these findings. Deficits in midwife communication in relation to established screening practice needs to be addressed through additional training ahead of full implementation of non-invasive prenatal testing into midwifery practice. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate ethnic minority women's experiences and opinions of perinatal mental health problems and the provision support services. Methods: An exploratory survey was undertaken using a questionnaire. Quantitative data were analysed using descriptive statistics and a simple thematic analysis was used for the qualitative data. A total of 51 responses from women of 14 different ethnic minority backgrounds were analysed. Findings: Women from minority ethnic groups face barriers to seeking help for perinatal mental ill health as a result of ongoing stigma, the poor attitudes and behaviours of health professionals and inappropriately designed services. Conclusions: Future interventions should focus on providing adequate cultural competency for health professionals and ensure that all women are able to access culturally appropriate spaces to talk and be listened to in community settings and wider services. [ABSTRACT FROM AUTHOR]

Aim: To identify the barriers to implementation of the Sepsis Six pathway. Background: Research has suggested that compliance with the Sepsis Six pathway remains low. Methods: A convenience sample of doctors and nurses from one emergency department, two medical wards and two surgical wards were asked to complete a survey questionnaire. Results: Data from 108 respondents were available for analysis. Doctors and nurses agreed that lack of sepsis recognition during observation rounds and failure to associate sepsis with deranged temperature and blood results acted as barriers to the identification of sepsis. Doctors and nurses agreed that nursing delays and knowledge deficits were the top barriers leading to delay in sepsis treatment. Conclusion: Knowledge deficits, lack of resources and practical issues were barriers identified in this survey. This will inform the educational and process needs of both doctors and nurses in order to improve sepsis care. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine perceived barriers to assessment of delirium for critical care nurses, and the impact of education on their knowledge and practice. Background: Delirium is a significant problem in critical care, leading to increased morbidity and mortality. Many authors have found variations in assessment by critical care nurses, but there has been limited analysis of the reasons for this. Education on the topic improves knowledge and practice, but the best approach has not been examined. Design: A questionnaire survey design. Methods: A self-reported questionnaire was distributed to critical care nurses (n=31) at a district general hospital. Data were analysed with descriptive statistics. Results: Knowledge and practice were variable, but correlation was seen between nursing band and years of experience with better scores. Any type of education led to significantly improved scores. Several barriers to assessment were found, with the most common being lack of knowledge and difficulty in assessing intubated patients. Conclusion: It is essential to improve practice in delirium assessment and management. Education is vital to improve the knowledge and practice of critical care nurses regarding delirium. [ABSTRACT FROM AUTHOR]

Aim: To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics. Methods: A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach’s alpha=0.91). Results: The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more ‘strongly agree’ responses than the doctor-led cohort (p<0.001, CI: 95%). Further analysis of the responses to each question demonstrated statistical significance when comparing the two cohorts. Conclusions: The study offered patients the opportunity to reflect on service delivery enabling a more responsive approach to health care within the colorectal 2ww service. It found that patient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research. [ABSTRACT FROM AUTHOR]

Background Maternal sepsis is the leading cause of direct maternal death in the UK. Cost-effective training for staff is essential in providing safe, high-quality maternity care. Aims This project aimed to examine the impact of a maternal sepsis training package, provided during the period 1 April – 30 September 2013 (quarters 2–3), on maternity staff ’s compliance with the Trust’s maternal sepsis guideline, as documented in maternity notes. Methods An audit was undertaken of the staff compliance rates for the Trust’s maternal sepsis guideline (on which the training package is based) recorded in maternal notes during the period 1 January – 31 December 2013 (quarters 1–4). Data were analysed to investigate significance. Findings There was no statistically significant increase in compliance with the guideline from quarter 1 through to quarter 4. Conclusions Despite its limitations, this audit suggests the training has not had a significant impact on practice. When an initiative starts to deliver results that are not providing value for money, reassessing services in the interest of quality care must be the priority. [ABSTRACT FROM AUTHOR]

Aim and objectives: to understand the purpose, impact and experience of nurse handover from patient and staff perspectives. Background: poor communication is increasingly recognised as a major factor in healthcare errors. Handover is a key risk point. Little consensus exists regarding the practice in nursing but the trend is towards bedside handover. Research on patient and staff experiences of handover is limited. Design: a qualitative and observational study on two acute wards in a large urban hospital in the UK. Methods: interviews conducted with patients and staff and observation of handovers, ward rounds and patient'staff interactions. Results: diverse forms of nurse handover were found, used in combination: office based (whole nursing team), nurse in charge (NIC) to NIC, and bedside. Patients' and nurses' views concurred on the purpose of bedside handover--transference of information about the patient between two nurses--and about the medical ward round, which was seen as a discussion with the patient. Views diverged regarding the purpose and value of office handover. Bedside handover differed in style, content, and place of delivery, often driven by concerns regarding confidentiality and talking over patients, and there were varied views on the benefits of patient involvement in bedside handover. Nurses worked beyond their shift end to complete handover. Communication problems within the clinical team were identified by staff and patients. Conclusions: while it is important to agree the purpose of handover and develop appropriate structure, content and style, it need not be a uniform process in all clinical areas. Nurse training to deliver bedside handover and patient information on the purpose of handover and the patient's role would be beneficial. [ABSTRACT FROM AUTHOR]

The aim of the current study was to use interviews to explore midwives' experiences of talking to pregnant women about smoking cessation. Eight midwives based in one UK hospital took part in face-to-face semi-structured interviews. Thematic analysis revealed that midwives were aware of health risks associated with smoking, saw providing smoking cessation advice as part of their role, would value more support from GPs, and were clear that support and a woman-centred approach were key. Failure to refer women for support was related to cumbersome or misunderstood referral procedures rather than reluctance to refer. [ABSTRACT FROM AUTHOR]

Objective: To study midwives’ knowledge, practice and opinions regarding advice about fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASDs) and alcohol intake in pregnancy. Design: A postal questionnaire was sent to 1862 midwives employed in 13 NHS Trusts in East Anglia, incorporating city and rural areas. Results: The authors received responses from 33.5% of the midwives contacted (n=624), of which 98% stated that alcohol abstinence in pregnancy would be their preferred advice, and 38% had seen an infant with FAS. Less than 2% indicated that they were ‘very prepared’ to deal with the subject. Only 10% identified all four classic features of FAS. Conclusions: More than a third of midwives had seen an infant with FAS. The advice given to pregnant mothers by participants varied. The midwives stated that they would like more information and support. Implications for practice: Expansion of midwives’ knowledge should improve the quality of antenatal advice, leading to better prevention, intervention and recognition of FASD in children. [ABSTRACT FROM AUTHOR]

● Objective: To evaluate a novel aqueous oxygen peroxide (AOP ) wound therapy (BioxyQuell) in a multi-centre, primary care-based, randomised, double-blind, placebo-controlled, parallel-group trial, monitoring long-term healing outcomes over 12 months. ● Method: Sixty-one patients with chronic, stable venous leg ulceration were treated with either AOP solution or sterile water placebo applied as a lavage over 2 weeks. The patients’ wounds were dressed weekly and assessed fortnightly over the following 6 weeks. Patients who completed the initial 8-week trial were invited into a 10-month follow-up trial. The primary endpoints of the study were wound healing at 8 weeks, 12 weeks, 6 months and 12 months, and wound size reduction during the treatment phase. Secondary endpoints were reductions in wound bioburden and pain. ● Results: Patients treated with AOP were more likely to heal at 6 months (p=0.014) and 12 months (p=0.006), but not at 8 weeks (p=0.979) or 12 weeks (p=0.263). Patients treated with AOP had greater wound area reduction (p=0.015), reductions in pain measured on a 100-point scale (p=0.001) and wound bioburden reduction (p=0.005) during the treatment phase. ● Conclusion: The addition of AOP treatment provides substantial benefits to patients with chronic venous leg ulceration compared with current best practice. [ABSTRACT FROM AUTHOR]

Background: Although informal end-of-life care is associated with significant physical and psychological morbidity for caregivers, few interventions have been developed to meet these needs. This study aimed to identify existing coping and support mechanisms among informal cancer caregivers in order to inform intervention development. Method: One-to-one semi-structured qualitative interviews were undertaken with 20 informal cancer caregivers of home palliative care patients. Results: Caregivers' existing coping strategies included distraction, mental stimulation, emotional release, looking for the positive aspects of caregiving, and disengaging from stressful thoughts. The majority of the participants described the importance of support and understanding from family and friends. Conclusions: The data suggests that feasible and acceptable interventions will be those that are targeted to caregivers to assist them in optimising existing coping strategies and support from family and friends. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine the incidence of pressure ulceration (PU) in patients treated with cervical spine immobilization. The study identified two patients who acquired tissue damage during the course of treatment with cervical immobilisation devices. The results indicate that patients with cervical spine immobilisation have an increased risk of developing PUs and require close monitoring to check the risk of developing PUs and overall management of the medical condition.

Individuals' attitudes stem partly from their personality traits, which may influence their interpersonal relationships with patients. Although personality traits are somewhat genetically determined, research has found that there are other factors that may influence this, such as self-esteem, family, social and clinical environments, and education. Part one of this article explained the research process of this cross-sectional descriptive study, which assessed the personality traits of two cohorts of nursing/midwifery students (n=116, aged 19-44 years) in their third year of the Diploma/BSc (Hons) programme at the University of Malta (Baldacchino and Galea, 2012). Data were collected in 2006 using the NEO Five-Factor Inventory (Costa and McCrae, 1992c). In part two, the authors demonstrate that students obtained low neuroticism scores, average openness scores, and high agreeableness, extraversion and conscientiousness scores. Irrespective of nursing/midwifery programmes, age and gender, similar mean scores were identified in all five personality domains. These findings are consistent with previous studies, with some exceptions related to significant differences in gender and religiosity. Further larger scale longitudinal research is recommended on nursing/midwifery and allied healthcare students, to exhibit a possible profile pattern across time and other influencing factors. [ABSTRACT FROM AUTHOR]