Managing support for newly qualified practitioners: lessons learnt from one health care region in the UK.

AIM: The study mapped the support provided for newly qualified practitioners across Kent, Surrey and Sussex. BACKGROUND: Newly qualified practitioners require support and guidance to facilitate their transition from student to their new role as qualified practitioner. Professional bodies advocate that programmes be provided but the type and intensity of that support is variable. METHODS: Telephone interviews were conducted with 24 people delivering support for newly qualified practitioners across professions in 13 different health care trusts. Documents (n = 41) related to support programmes were analysed. Two case study site visits and a knowledge exchange conference of 45 delegates completed the data collection. Data were analysed using the constant comparative method of analysis. RESULTS: Support for newly qualified practitioners was largely idiosyncratic to profession and Trust. Evidence emerged of a conceptual shift from basic competency acquisition toward a corporate induction programme. CONCLUSIONS: Interdisciplinary programmes can provide generic transitional support, but the newly qualified practitioners favoured skill acquisition to help them to be effective in their new role. Measuring the impact of newly qualified practitioner support on patient outcome and the practitioner is required. IMPLICATIONS FOR NURSING MANAGEMENT: A career pathway for those who support newly qualified practitioners and one that includes specific preparation for the role is proposed.

CanPrevent: a telephone-delivered intervention to reduce multiple behavioural risk factors for colorectal cancer.

BACKGROUND: This pilot study aimed to test the acceptability and short-term effectiveness of a telephone-delivered multiple health behaviour change intervention for relatives of colorectal cancer survivors. METHODS: A community-based sample of 22 first-degree relatives of colorectal cancer survivors were recruited via a media release. Data were collected at baseline and at six weeks (post-intervention). Outcome measures included health behaviours (physical activity, television viewing, diet, alcohol, body mass index, waist circumference and smoking), health-related quality of life (Short Form-36) and perceived colorectal cancer risk. Intervention satisfaction levels were also measured. The intervention included six telephone health coaching sessions, a participant handbook and a pedometer. It focused on behavioural risk factors for colorectal cancer [physical activity, diet (red and processed meat consumption, fruit and vegetable intake), alcohol, weight management and smoking], and colorectal cancer risk. RESULTS: From baseline to six weeks, improvements were observed for minutes moderate-vigorous physical activity (150.7 minutes), processed meat intake (-1.2 serves/week), vegetable intake (1 serve/day), alcohol intake (-0.4 standard drinks/day), body mass index (-1.4 kg/m2), and waist circumference (-5.1 cm). Improvements were also observed for physical (3.3) and mental (4.4) health-related quality of life. Further, compared with baseline, participants were more likely to meet Australian recommendations post-intervention for: moderate-vigorous physical activity (27.3 vs 59.1%); fruit intake (68.2 vs 81.8%); vegetable intake (4.6 vs 18.2%); alcohol consumption (59.1 vs 72.7%); body mass index (31.8 vs 45.5%) and waist circumference (18.2 vs 27.3%). At six weeks participants were more likely to believe a diagnosis of CRC was related to family history, and there was a decrease in their perceived risk of developing CRC in their lifetime following participation in CanPrevent. The intervention retention rate was 100%, participants reported that it was highly acceptable and they would recommend it to others at risk of colorectal cancer. CONCLUSIONS: Positive behaviour change achieved through this intervention approach has the potential to impact on the progression of CRC and other cancers or chronic diseases. A large scale randomised controlled trial is required to confirm the positive results of this acceptability and short-term effectiveness study. TRIAL REGISTRATION: ACTRN12612000516886.

Therapeutic use of cannabis.

Therapeutic cannabis use raises a number of dilemmas for nurses. This article examines the legal, political and ethical challenges raised by the use of cannabis by people with life-limiting or terminal illnesses in their own homes. (Throughout this paper, the term cannabis refers to illegal cannabis unless specified.) A literature review of databases from 1996 was conducted and internet material was also examined. Evidence on the therapeutic use of cannabis suggests it may produce improvements in quality of life, which has led to increased use among people with life-limiting illnesses. The cannabis used is usually obtained illegally, which can have consequences for both those who use it and nurses who provide treatment in the community.

Australian guidelines for physical activity in pregnancy and postpartum.

OBJECTIVES: To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period. DESIGN: Critical 'umbrella' reviews of the scientific evidence, combined with adaptation of recently published guidelines. METHODS: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines. RESULTS: Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy. CONCLUSIONS: All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided.

Cannabis use in palliative care - an examination of the evidence and the implications for nurses.

AIM AND OBJECTIVE: Examine the pharmaceutical qualities of cannabis including a historical overview of cannabis use. Discuss the use of cannabis as a clinical intervention for people experiencing palliative care, including those with life-threatening chronic illness such as multiple sclerosis and motor neurone disease [amyotrophic lateral sclerosis] in the UK. BACKGROUND: The non-medicinal use of cannabis has been well documented in the media. There is a growing scientific literature on the benefits of cannabis in symptom management in cancer care. Service users, nurses and carers need to be aware of the implications for care and treatment if cannabis is being used medicinally. DESIGN: A comprehensive literature review. METHOD: Literature searches were made of databases from 1996 using the term cannabis and the combination terms of cannabis and palliative care; symptom management; cancer; oncology; chronic illness; motor neurone disease/amyotrophic lateral sclerosis; and multiple sclerosis. Internet material provided for service users searching for information about the medicinal use of cannabis was also examined. RESULTS: The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care. RELEVANCE TO CLINICAL PRACTICE: Questions and dilemmas are raised concerning the role of the nurse when caring and supporting a person making therapeutic use of cannabis.

Randomized trial of three strategies to promote physical activity in general practice.

OBJECTIVE: To evaluate three strategies for promoting physical activity (PA) in a primary care setting. METHOD: Data were collected between 2002 and 2004 from 136 patients attending two general practices in Brisbane, Australia. Inactive patients (50-70 years) were randomly allocated to one of three hierarchical intervention groups: the general practitioner (GP) group received 'brief' advice; the GP+ES group also received behavior change advice from an exercise scientist (ES); and the GP+ES+P group also received a pedometer. Self-reported PA and its determinants were measured at baseline and weeks 12 and 24. Cardio-respiratory variables were measured at baseline and week 12. RESULTS: Overall, mean PA time increased by 84 and 128 min/week at weeks 12 and 24 (p<.01) with no significant group differences. Small improvements in blood pressure and post-exercise heart rate were observed. At week 24, the GP+ES+P group were more likely to report meeting PA guidelines than the GP group (OR=2.39 95% CI: 1.01, 5.64). CONCLUSION: PA levels can be increased in mid- to older-age adults, either by brief advice from motivated GPs alone, or from collaboration between GPs and ESs. The most intense intervention (GP+ES+P) showed the most promising results.

Provision of continued professional development for non-medical prescribers within a South of England Strategic Health Authority: a report on a training needs analysis.

AIMS: This paper reports on a Training Needs Analysis for Non-Medical Prescribers commissioned by a south of England Strategic Health Authority. BACKGROUND: The aim of the TNA was to inform future policy, educational provision and practice development and provide nurse managers with significant information on the perceived Continuing Professional Development (CPD) needs of the non-medical prescribers. METHODS: Data were collected from a sample of 270 non-medical prescribers using an in-depth questionnaire, and telephone interviews with a purposive sample of 11 key stakeholders. RESULTS: The findings report: * The qualifications that non-medical prescribers possess. * The level of confidence described by the non-medical prescribers in their role. * What non-medical prescribers identify as their present and future CPD requirements in relation to prescribing. * What education and training provision non-medical prescribers have attended in relation to their prescribing role since qualifying. CONCLUSIONS: The findings suggest, first that short courses that were specific to the non-medical prescribers role were considered to be the most popular and useful. However, courses needed to be advertised well in advance. Second, training gaps were identified. IMPLICATIONS FOR NURSING MANAGEMENT: Pharmacology and prescribing are rapidly changing and require regular CPD in order to keep up to date with the latest developments. Non-medical prescribing is a comparatively new innovation to the NHS, therefore those who are not medically qualified need mentorship from experienced prescribers, as well as the encouragement from nurse managers to be confident prescribers themselves and enhance patient care.

An education programme for professionals who specialize in substance misuse in St. Petersburg, Russia: part 2.

This paper extends the account of a joint project of education and training of doctors and nurses in St. Petersburg, Russia funded by the Know How Fund Health Sector Small Partnership Scheme (Russia) (). It reports the findings of two evaluations of the project. The first, an external evaluation was carried on behalf of the sponsors, the KHF. The second was an 'insider' evaluation utilising a framework developed for the English National Board by Cranfield and Stoneman. The paper concludes with a discussion of issues arising from the cross-cultural evaluations.

Evaluating the impact of a partnership for creating change in substance misuse practice in St. Petersburg, Russia.

This paper reports on an evaluation of an innovative education and training programme for nurses and narcologists in St. Petersburg, Russia. The aims of the evaluation were: first, to evaluate the effect of the education and training programme on the clinical practice of doctors and nurses who have had direct contact with the programme and, second, to evaluate the influence of the education and training programme on city-wide drug and alcohol policy and practice. Brief contextual information regarding the programme is provided prior to an account of the qualitative methodology. Particular attention was paid to the work of Patton [Utilisation-focused evaluation, second ed., Sage, London, 1986; Qualitative research and evaluation methods, third ed., Sage, London, 2002] for the theoretical framework and to Hantais and Mangen [Cross-national research methods in the social sciences, Pinter, London, 1996] regarding the methodological issues that surround international and cross-cultural research projects. Data collection was carried out in St. Petersburg and in the United Kingdom, which involved key participants in the programme. The data analysis followed Miles and Huberman [Qualitative data analysis. An expanded sourcebook, second ed. Sage, Thousand Oaks, 1994] which yielded six major themes: rehabilitation, the role and continuing professional development of the trained nurse; the status of the nurse training-college and the staff, small scale projects and their significance; sharing experiences/networking/face-to-face meetings; and, lack of resistance. The findings are discussed and recommendations for further involvement are identified.

Skeletal muscle phenotype is associated with exercise tolerance in patients with peripheral arterial disease.

OBJECTIVE: To better understand the association between skeletal muscle and exercise intolerance in peripheral arterial disease (PAD), we assessed treadmill-walking performance and gastrocnemius muscle phenotype in healthy control subjects and in patients with PAD. We hypothesized that gastrocnemius muscle characteristics would be altered in PAD compared with control subjects and that exercise tolerance in patients PAD would be related to muscle phenotype. METHODS: Sixteen patients with PAD and intermittent claudication and 13 healthy controls of the same age participated. Each subject completed a graded treadmill-walking test and underwent a resting muscle biopsy. Muscle biopsy samples were obtained from the medial gastrocnemius muscle of the most ischemic limb in PAD and a limb chosen at random in controls. Samples were analyzed for fiber type and cross-sectional area, capillary-to-fiber ratio, the number of capillaries in contact with each fiber type, and the optical density of glycogen within each fiber by using histochemical procedures. Total muscle glycogen content was determined biochemically. RESULTS: Exercise capacity measured on the incremental walking test in the PAD group was only 30% to 40% of that observed in controls. The PAD group had a lower proportion of type I muscle fibers (P < .05), fewer capillaries per muscle fiber (P < .05), and tended to have smaller fiber areas (P = .08). The relative area of type I fibers, the capillary-to-fiber ratio, capillary contacts with type I and IIa fibers, and the optical density of glycogen in type I fibers were all positively correlated with exercise tolerance in the PAD group (P < .05) but not controls. CONCLUSIONS: These data suggest that muscle phenotype is altered in PAD and that such alterations are associated with the exercise intolerance in these patients. In light of these findings, therapies such as resistance training or electrical stimulation that target skeletal muscle in PAD may prove beneficial, and further investigation of such therapies is warranted.

Walking performance, oxygen uptake kinetics and resting muscle pyruvate dehydrogenase complex activity in peripheral arterial disease.

In the present study, we tested the hypothesis that walking intolerance in intermittent claudication (IC) is related to both slowed whole body oxygen uptake (VO2) kinetics and altered activity of the active fraction of the pyruvate dehydrogenase complex (PDCa) in skeletal muscle. Ten patients with IC and peripheral arterial disease [ankle/brachial index (ABI)=0.73 +/- 0.13] and eight healthy controls (ABI=1.17 +/- 0.13) completed three maximal walking tests. From these tests, averaged estimates of walking time, peak VO2 and the time constant of VO2 (tau) during submaximal walking were obtained. A muscle sample was taken from the gastrocnemius medialis muscle at rest and analysed for PDCa and several other biochemical variables. Walking time and peak VO2 were approx. 50% lower in patients with IC than controls, and tau was 2-fold higher (P<0.05). tau was significantly correlated with walking time (r=-0.72) and peak VO2 (r=-0.66) in patients with IC, but not in controls. PDCa was not significantly lower in patients with IC than controls; however, PDCa tended to be correlated with tau (r=-0.56, P=0.09) in patients with IC, but not in controls (r=-0.14). A similar correlation was observed between resting ABI and tau (r=-0.63, P=0.05) in patients with IC. These data suggest that the impaired VO2 kinetics contributes to walking intolerance in IC and that, within a group of patients with IC, differences in VO2 kinetics might be partly linked to differences in muscle carbohydrate oxidation.