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Screening of acute stroke patients for signs of dysphagia (swallowing impairment) is recommended within 24 hours of hospitalization owing to increased risk of morbidity and mortality Speech and language therapists (SLTs) are the lead health professionals responsible for assessment of dysphagia. However, increasing demand for assessment and the relative dearth of SLTs in the NHS has resulted in delays in assessment of up to 6 days. Subsequently there is a drive for nurses to perform this screening process using a validated screening method and tool. This paper centres on the exploratory phase of a three-stage programme of research, designed to develop and evaluate a bedside dysphagia screening tool for use by registered nurses. Here the authors focus on a review of the salient professional literature and the findings of a survey of current dysphagia screening practices employed by nurses across 52 NHS trusts in England and Wales. The literature review revealed a lack of consensus on the requisite construct of a dysphagia screening tool and on criteria for determining signs of swallowing difficulties and their complications. These reported findings were echoed in the survey which highlighted wide variation in screening practices and use of screening criteria based on limited or no research-based evidence. The authors describe how this initial work has acted as a springboard for the design and evaluation of a screening tool for use by nurses at the patient's bedside, which employs a minimal combination of evidence-based criteria. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to examine the pain profile of three types of day surgery operation and undertake a comparative analysis of the intensity and duration of pain over a consecutive 4-day period. Background. Although studies on pain after day surgery have figured prominently, evidence is limited as to what intensity and duration of pain should be regarded as unacceptable, and how it varies for different operation types. Methods. A prospective postal survey ( n = 785) was undertaken during a 12-month period in 1998/1999 involving three day surgery units in three different areas in England and Wales and based on three commonly performed operation types: hernia repair, varicose vein surgery and laparoscopic sterilization. A visual analogue scale was used to measure the intensity of pain experienced over a 4-day consecutive time period. Analysis of variance was used to explore statistically significant differences between levels of pain for the operation types. Results. On the day of surgery and even on the third postoperative day, high levels of severe pain (>50 mm on a Visual Analogue Scale) were experienced. Pain levels differed across different operation types. On the day of surgery, more patients undergoing laparoscopic sterilization experienced severe pain. By the third postoperative day, more of those who had been operated on for hernia repair, followed by varicose vein surgery and laparoscopic sterilization, continued to experience severe pain. Conclusion. A large number of patients experienced severe levels of pain after day surgery. This could have resulted from a lack of knowledge about the assessment and management of pain, in which nurses play an important role. This study has highlighted that different pain trajectories are associated with different operation types, and this has important implications for the preoperative and postoperative preparation of day surgery patients as well as the role of nurses in the overall success of the day surgery process. [ABSTRACT FROM AUTHOR]

ameen j., coll a.m.&peters m. (2005) Journal of Advanced Nursing50(6), 583–594Impact of tele-advice on community nurses’ knowledge of venous leg ulcer careThis paper reports a study assessing the impact of the provision of expert tele-advice to community nurses in enhancing their knowledge of leg ulcer care.Community nurses have traditionally been responsible for the care of patients with leg ulcers. However, access to expert medical and nursing advice has been restricted to the local hospital environment. The introduction of e-health and telemedicine have created opportunities to provide online and immediate access to wound care expertise from centres of excellence to primary health care staff in managing patients’ wounds in their own home.A stratified randomized controlled trial was used to examine community nurses’ knowledge before and after the provision of expert tele-advice. A knowledge measurement tool comprised of 40 multiple-choice questions was adopted, with correct responses identified by a panel of wound care experts. The questions covered the three themes of dressings, management and physiology, with different levels of difficulty categorized as easy, medium or difficult. The tool was administered before and after the intervention (12 weeks) to both the experimental and control groups.Statistically significant improvements were observed only for the experimental group in the areas of dressings and management, as well as in the medium level questions. No statistically significant improvement was seen for the easy questions, as there was little room for improvement because of preintervention high scores. For the difficult questions, it was thought that more time would be needed for a more positive outcome.The results suggest that tele-advice can be of great benefit to community nurses in enhancing their knowledge in the practice of leg ulcer care. This will have significant implications for more efficient use of human resources and cost effectiveness in wound care. [ABSTRACT FROM AUTHOR]