Pros and cons of using apps in clinical practice.

There is a lack of research on the use of smartphone apps among nurses in the UK, but the number of healthcare-related apps is increasing and it is likely that nurses will want to include them in practice. It will, therefore, be necessary to assess their effectiveness, appropriateness and efficacy to ensure they enhance patient care. This article looks at the literature on the subject and suggests some issues managers should consider before allowing the use of apps in their clinical areas. It also invites readers to take part in a survey on the use of apps in nursing.

Bladder cancer risk stratification using a urinary mRNA biomarker panel - A path towards cystoscopy triaging.

OBJECTIVES: The risk of bladder cancer (BCa) diagnosis and recurrence necessitates cystoscopy. Improved risk stratification may inform personalized triage and surveillance strategies. We aim to develop a urinary mRNA biomarker panel for risk stratification in patients undergoing BCa screening and surveillance. METHODS AND MATERIALS: Urine samples were collected from patients undergoing cystoscopy for BCa screening or surveillance. In patients who underwent transurethral resection of bladder tumor, urine samples were categorized based on tumor histopathology, size, and focality. Subjects with intermediate and high-risk BCa based on American Urological Association (AUA) guideline for non-muscle invasive bladder cancer were classified as "increased-risk"; those with no cancer and AUA low-risk BCa were classified as "low-risk". Urine was evaluated for ROBO1, WNT5A, CDC42BPB, ABL1, CRH, IGF2, ANXA10, and UPK1B expression. A diagnostic model to detect "increased-risk" BCa was created using forward logistic regression analysis of cycle threshold values. Model validation was performed with ten-fold cross-validation. Sensitivity and specificity for detection of "increased-risk" BCa was determined and net benefit analysis performed. RESULTS: Urine samples (n = 257) were collected from 177 patients (95 screening, 76 surveillance, 6 both). There were 65 diagnoses of BCa (12 low, 22 intermediate, 31 high risk). ROBO1, CRH, and IGF2 expression correlated with "increased-risk" disease yielding sensitivity of 92.5% (95% CI, 84.9%-98.1%) and specificity of 73.5% (95% CI, 67.7-79.9%). The overall calculated standardized net benefit of the model was 0.81 (95%CI, 0.71-0.90). CONCLUSIONS: A 3-marker urinary mRNA panel allows for non-invasive identification of "increased-risk" BCa and with further validation may prove to be a tool to reduce the need for cystoscopies in low-risk patients.

Developing the children's nursing workforce: profile, first jobs and future plans of newly qualified diplomates.

Concerns regarding the number of children's nurses persist despite initiatives designed to reverse this trend. Recruiting and retaining a diverse nursing workforce is high on the policy agenda, particularly since the publication of the National Service Framework for Children, Young People and Maternity Services. This article reports findings from the first phase of a longitudinal study investigating the careers of child branch diplomates, focusing on the cohort's profile, first jobs and future plans. Findings suggest there is considerable scope to increase diversity in the children's nursing workforce. Child health diplomates indicate little sign of early attrition from nursing at qualification. Continuing professional development is a high priority for many child health nurses at the outset of their careers. These findings provide an important benchmark for later stages of child branch nurses' careers.

Parents' views about infant pain in neonatal intensive care.

OBJECTIVE: The purpose of this study was to describe parents' perceptions and feelings about their infant's pain experience and pain care in the neonatal intensive care unit. METHOD: Thematic content analysis was used to encode the qualitative information contained in parents' written comments on a questionnaire about their views on infant pain and pain care. The questionnaire was completed by 257 parents from 9 neonatal units in the United Kingdom (n = 196) and 2 neonatal units in the United States (n = 61). RESULTS: Parents' comments indicated that they saw medical procedures as the major source of their infant's pain, wanted more information, and generally desired more involvement in this aspect of their infant's care. Parents' comments indicated that their infant's pain affected them emotionally and that they worried about their future relationship with their infant. Parents also articulated specific ways in which health care professionals could assist them and their infants in coping with neonatal intensive care unit-related pain. DISCUSSION: The findings from this study expand knowledge about how parents understand and respond to the difficult situation in which their newborn infant is subjected to essential but painful procedures. The findings provide direction for research and clinical practice interventions aimed at: 1) helping parents to gain knowledge and correct their misperceptions; 2) engaging parents in meaningful dialog about their concerns and preferences for involvement; and 3) helping parents to develop effective coping strategies to reduce psychologic distress related to their infant's pain.

Beginning literacy: links among teacher knowledge, teacher practice, and student learning.

Although the importance of phonological awareness has been discussed widely in the research literature, the concept is not well understood by many classroom teachers. In the study described here, we worked with groups of kindergarten and first-grade teachers (the experimental group) during a 2-week summer institute and throughout the school year. We shared with them research about learning disabilities and effective instruction, stressing the importance of explicit instruction in phonological and orthographic awareness. We followed the experimental group and a control group into their classrooms for a year, assessing teachers' classroom practices and their students' (n = 779) learning. The study yielded three major findings: We can deepen teachers' own knowledge of the role of phonological and orthographic information in literacy instruction; teachers can use that knowledge to change classroom practice; and changes in teacher knowledge and classroom practice can improve student learning.

Planning a career as a children's nurse: the availability of career guidance during the nurse diploma course.

The recruitment and retention of registered children's nurses is paramount to the implementation of the national service framework for children's services. In recent years there have been increased career opportunities for children's nurses and a diversity of career pathways. Career guidance has a potential contribution to make to the effective management of nurses' careers. This article presents findings on child health diplomates' experiences of career guidance during the nurse diploma course. Findings indicate a substantial unmet demand for career guidance. The implications of the findings for child health nurses' careers are discussed and considered in relation to two key questions: should efforts be directed towards ensuring greater provision of career guidance, and if so, by whom?

Careers in child health nursing: the influence of course experiences.

Findings presented in this paper are drawn from a longitudinal study of nurses' careers (Robinson et al 1998, 1999). As part of this study, a large cohort of child branch diplomates were asked about their clinical experience while on the course and its effects on their initial work plans. For 12 of the 23 specialties listed, more than half of the 634 respondents felt that they did not have sufficient experience to comment. Findings indicate that there were five specialties which more than half of those who had experience during the course felt encouraged to work in: general paediatrics (73 per cent), community (63 per cent), oncology (60 per cent), PICU (59 per cent), and cardiac (53 per cent). Overall, course experiences were more likely to encourage than discourage diplomates from wanting to work in a particular specialty; this was the case for 19 of the 23 specialties. Course experiences were significantly more likely to have discouraged than encouraged diplomates from considering working in theatres and psychiatry. Seventy-seven per cent of respondents (417) had obtained a first job in their preferred clinical specialty. Findings from this study indicate that course experiences influence the initial career plans of child branch diplomates. Data obtained from further phases of this longitudinal study will indicate to what extent course experiences influence later career decisions.

Measuring neonatal intensive care unit-related parental stress.

AIMS: This paper reports a study: (1) to determine the validity and reliability of the Parent Stressor Scale:Neonatal Intensive Care Unit (PSS:NICU) for use with United Kingdom (UK) parents; (2) compare UK scores with those from a contemporary reference sample from the United States (US), (3) to identify the sources of greatest NICU-related stressors for parents and (4) to identify demographic or situational factors influencing NICU-related parental stress. BACKGROUND: Evaluation of the adequacy of nursing care and psychosocial support services for parents of ill infants in the NICU requires valid and reliable measures of parental stress. The PSS:NICU is a well-validated scale developed in the US to measure NICU-related parental stress. However, it has not been tested in the UK. METHODS: Consecutive samples of parents (n = 257) of infants in nine UK NICUs and two reference US units completed the PSS:NICU and the Spielberger State-Trait Anxiety Scale approximately 1 week after admission. Psychometric properties of the PSS:NICU, including internal consistency reliability and construct, concurrent and predictive validity, were evaluated. RESULTS: PSS:NICU scores were similar in the UK and US samples and high internal consistency reliability was found for all metrics (e.g. Overall Stress: 0.94 for both samples). A three-factor principal components solution accounted for 66% of the variance in the scores, with the items grouped into the three a priori scales specified in the PSS:NICU (Infant Behaviour and Appearance, Parental Role Alterations, and Sights and Sounds). Stress Occurrence and Overall Stress were moderately correlated with State Anxiety in both samples (r = 0.46-0.61, P < 0.001). Thirty-one per cent of the variance in Stress Occurrence in the UK sample was explained by State Anxiety, infant severity of illness score, parent gender, and less frequent visitation. CONCLUSIONS: The PSS:NICU demonstrated appropriate psychometrics in a large sample of parents from diverse NICUs in the UK. These findings support its wider use in research and clinical practice to identify parental distress and evaluate the effectiveness of nursing care and psychosocial support services for parents.