Thursday, 8 October 2015

Cardiac rehabilitation in Australia

Roger Watson, Editor

Not all patients are able to attend hospital after a myocardial infarction for rehabilitation, and programmes have been designed to enable them to undertake rehabilitation at home.  This study from Australia by Frohmader et al. (2015) titled: 'Patient perceptions of nurse mentors facilitating the Aussie Heart Guide: A home-based cardiac rehabilitation programme for rural patients' and published in Nursing Open was designed to: 'To explore and describe long-term thoughts and perceptions of the Aussie Heart Guide Programme including the role of the mentor, held by patients recovering from myocardial infarction.'

The research was carried out by interviewing 13 patients at home by telephone once they had completed the programme.  Views were generally positive and, in the words of one participant: 'I live a long way from the city. I do not go to the local doctor much. I am very isolated. The mentor helped me cope after being discharged from hospital.'  In terms of support, one patient said: 'I was really down in the dumps for about 3 months after my heart attack. I’m not sure if it was because I went through a lot in hospital or because of my age but I found the mentor phone calls to help somewhat.'

In conclusion the authors say: 'The findings from this study support the provision of the Aussie Heart Guide Programme as a home-based self-help programme for patients recovering from MI who find it geographically difficult to attend hospital-based cardiac rehabilitiation programs'  and: 'Mentors were perceived to be integral to the success of the programme through the provision of timely information, ongoing psychosocial support and lifestyle advice to patients during their recovery from myocardial infarction.'

Reference

Frohmader TJ, Lin F, Chaboyer W (2015) Patient perceptions of nurse mentors facilitating the Aussie Heart Guide: A home-based cardiac rehabilitation programme for rural patients. Nursing Open doi: 10.1002/nop2.34

Mary Seacole's place in the development of modern nursing

Roger Watson, Editor

In the history of modern nursing two figures emerge: Mary Seacole and Florence Nightingale.  Florence Nightingale's place in this history is well documented and well known and her legacy, especially in the UK, is obvious.
Mary Seaciole
 However, in recent decades another figure - Mary Seacole - has emerged both as an important figure in the history of nursing and for her work in the Crimea but also because she is championed and has largely been adopted by black nurses the world over.  The campaign to have a Seacole statue erected as a permanent memorial in London would represent one of the first statues of an important black figure in the UK.

Florence Nightingale
However, as she has done before (McDonald 2013), the Canadian Nightingale scholar Lynn McDonald has questioned the place and contribution of Seacole in the pages of Nursing Open in an article titled: 'Mary Seacole and claims of evidence-based practice and global influence.'  McDonald's initial article in JAN drew an indirect response from some European Seacole scholars Staring-Derks et al. (2015) and, essentially, the most recent article by McDonald is a response.

Clearly, I don't expect that many will agree with McDonald's arguments and may question their publication.  In my view her points are well made and supported by credible sources and she has a right - provided that due processes are followed - to be heard.  As with the 2013 in JAN, I would welcome any rejoinders either on this blog or on JAN interactive or in the pages of either journal.  

References

McDonald L. (2014Florence Nightingale and Mary Seacole on nursing and health care Journal of Advanced Nursing 70(6), 14361444. doi: 10.1111/jan.12291

McDonald L (2015) Mary Seacole and claims of evidence-based practice and global influence Nursing Open doi: 10.1002/nop2.32

Staring-Derks C.Staring J. & Anionwu E.N. (2015Mary Seacole: global nurse extraordinaire Journal of Advanced Nursing 71(3), 514525. doi: 10.1111/jan.12559

Pain management in children

Roger Watson, Editor

Pain in children needs particular attention as some children may have difficulty in describing their pain and may not understand why they are in pain.  Also, there are pharmacological issues to be taken into account with children in terms of dosage and frequency of administration of analgesia.

As this UK study by Beckett et al. (2105) titled: 'A mixed-method study of pain management practice in a UK children’s hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management' and published in Nursing Open states: 'UK paediatric acute pain services vary. Although comprehensive pain management guidelines exist, consensus on the best model of care is lacking.'  And, despite the evolution of specialist acute pain services (APSs), 'their overall efficacy is unknown.'

The study looked at pain management practices over two weeks in one hospital with children who were inpatients and interviews were held with staff.  Referrals and non-referrals to the APS were studied and all were made appropriately.  The authors report that: 'Acute Pain Services cases experienced higher pain levels, were more likely to have long term conditions, longer hospital stay and repeat admissions.'  These data and the interviews suggest that APSs are effective but that they are likely to become overburdened as they are often viewed as a generic pain advise service.  Therefore, despite the success of the APS studied, the authors conclude: 'However, without forward planning and simultaneous investment in training there is a risk that pain becomes increasingly specialized, that responsibility for managing other forms of difficult-to-treat pain becomes blurred and that front-line staff lack the ability to provide timely effective care.'

Reference

Beckett K, Henderson EM, Parry S, Stoddart P, Fletcher M (2015) A mixed-method study of pain management practice in a UK children’s hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management Nursing Open doi: 10.1002/nop2.33

Discharge planning in Japan

Roger Watson, Editor

The aim of this study from Japan by Sakai et al. (2015) titled 'Developing an instrument to self-evaluate the Discharge Planning of Ward Nurses' and published in Nursing Open was 'To develop the Discharge Planning of Ward Nurses (DPWN), a Japanese self evaluation instrument for ward nurses’ discharge planning practices.'  As the authors explain: As part of this shift in the healthcare system, enormous
efforts have been attempted to shorten the average length of hospital stay. As a result of this shortened length of hospital stay, older adult patients often leave the hospital with altered independence levels and vulnerable health conditions. These older adults frequently have difficulty when leaving the hospital.'  For this reason, and especially in Japan where families get very anxious at discharge and feel their relatives have been rushed out of hospital, improved assessment is necessary.

An initial 55 items was reduced statistically to produce a 25-item scale with four dimensions.  The authors conclude: 'The DPWN might be used for various purposes, such as to enable ward nurses to self-evaluate their own practices and to assess the effectiveness of educational programmes for ward nurses. Additionally, it might be useful in creating educational tools aimed at developing nurses’
discharge planning competencies; moreover, new nurses may also be mentored using the tools, thus aiding the development of an educational pathway. Furthermore, assessing discharge outcomes such as patient/family satisfaction might be possible. More studies are needed to further examine the clinical utility of the DPWN both nationally and internationally.

Reference

Sakai1 S, Yamamoto-Mitani N, Takai Y, Fukahori H, Ogata Y (2015) Developing an instrument to self-evaluate the Discharge Planning of Ward Nurses Nursing Open doi: 10.1002/nop2.31

Nursing handovers as a source or error

Roger Watson, Editor


Nursing handovers are the opportunity—between nursing shifts—to share information about patients and to discuss care priorities. They take place collectively and individually, their effectiveness is questionable and they may be one of the ‘rituals’ of nursing. However, if inaccurate information is transmitted then they can, potentially, do great harm. In this study from Switzerland by Mayor and Bangerter (2015) titled: 'Managing perturbations during handover meetings: a joint activity framework’ nursing handovers are investigated.

In the words of the authors: ‘Handovers are joint activities performed collaboratively by participating nurses. Perturbations of handover are frequent and may potentially threaten continuity of care.’ To conduct the study, handovers were videotaped and transcribed over several days. Unfortunately, nurses were the source of ‘perturbations’ which led to mistakes in the handovers. The article is presented with photographs to illustrate one incident and excerpts from the transcripts.

In the discussion, the authors state: ‘Perturbations are managed via a tacit division of labour according to nurses’ temporal status as incoming or outgoing. As outgoing nurses who are not giving the report will subsequently leave, they are thus more available to deal with perturbations. Incoming nurses need to process information discussed during the handover, but can deal with perturbations to some extent because their colleagues can still repeat information to them after the handover. Outgoing nurses giving the report are least likely to handle perturbations.’


Reference

Mayor E, Bangerter A (2015) Managing perturbations during handover meetings: a joint activity framework Nursing Open doi: 10.1002/nop2.29


How useful is pre-nursing experience?

Roger Watson, Editor


Keeping people in nursing is a problem as is keeping nursing students in nursing education in the UK. Dropout from universities is high, many never enter nursing after graduation and many leave early. But how do we attract people into nursing and ensure that the ones who come in are suited to the programme of study and to working as nurses? A Scottish study reported by Smith et al. (2105) in an article titled: 'I know exactly what I’m going into”: recommendations for pre-nursing experience from an evaluation of a pre-nursing scholarship in rural Scotland' reports on the experiences of school pupils undertaking a residential period of experience in some aspects of nursing. In the words of the authors, the aims of the scholarship were 'to inspire school leavers to consider nursing careers, aspire to university-level education and alert pupils to the availability of nurse education closer to home.'

Forty two school pupils (n = 42) completed questionnaires and participated in anecdote circles and 33 student nurses acting as pupil ‘buddies’ participated in focus groups. The programme was successful in increasing the number of pupils who wanted to become nurses and those who did made very positive comments such as: 'I now know for sure I want to be a nurse.' Pupils particularly enjoyed clinical skills experience and liked being treated, educationally, as adults. Some realised how difficult nursing was but also that they were able to speak to patients. Ten specific recommendations for running such schemes are provided in the article by Smith et al. (2015)


Reference

Smith A, Beatttie M, Kyle RG (2015) “I know exactly what I’m going into”: recommendations for pre-nursing experience from an evaluation of a pre-nursing scholarship in rural Scotland Nursing Open doi: 10.1002/nop2.23

Patient repositioning

Seamus Cowman, Associate Editor

Patient repositioning is a frequently implemented pressure injury prevention strategy. The surprising thing is that, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility. A new study by Latimer et al. 2015: ‘The repositioning of hospitalized patients with reduced mobility: a prospective study’ published in Nursing Open, provides new insights for health professionals in planning care for pressure ulcer, at risk patients. The problem of pressure ulcers represents a serious failing in the delivery of health services and it remains as an enigma to health service professionals and administrators alike as this is largely a preventable problem.


This observational study incorporated two data collection methods: chart audits and semi-structured observations. Using a consecutive sampling plan, 241 participants were recruited from two large Australian hospitals with one of the inclusion criteria being reduced mobility. The results showed that patients were repositioned more frequently than might have been previously believed and were observed to be repositioned on average 15 times over a 24 hour period. A lack of patient understanding about proper positioning for prevention of pressure ulcers is an important finding. Interestingly older patients and males were repositioned less frequently, placing them at greater risk for PI development. Patients were repositioned less at night than they were during the day.

The study has many basic findings which should be of great significance to health professionals in their efforts to tackle a mostly preventable health problem. The authors in their conclusion echo a recommendation that is a recurring theme from the literature on pressure ulcers: ‘Targeted and individualized pressure injury prevention management should be incorporated into clinical practice, however, this can only be achieved with nurses support and concurrent organizational support’.

Reference

Latimer S, Chaboyer W, Gillespie BM (2015) The repositioning of hospitalized patients with reduced mobility: a prospective study Nursing Open doi: