An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour.

OBJECTIVE: to evaluate the feasibility of a randomised controlled trial (RCT) examining the effect of three options (augmentation, conservative and water) for the management of dystocia in nulliparae. The main objectives were to explore the feasibility of trial procedures in the clinical environment, consent rates and acceptability of the management options to women, local incidence of dystocia in nulliparae and the size of the subsequent study. DESIGN: a two part study: a pilot, RCT with follow-up through to delivery with postnatal maternal surveys, and a case review of nulliparae with dystocia. SETTING: a large maternity unit in the South of England in May-July 1997 inclusive. PARTICIPANTS: nulliparae with dystocia in the first stage of labour who had an otherwise uncomplicated obstetric background. INTERVENTIONS: women in the pilot RCT received one of three management options: labouring in a waterbirth pool, conservative management or augmentation of labour, which is the standard management of women with dystocia condition in the Unit. FINDINGS: it is feasible to conduct an RCT of management of dystocia in the Unit. Seventy per cent (95% confidence interval 47% to 87%) of women approached agreed to participate. Conservative management was the least acceptable option to women and has been dropped from the subsequent trial. The audit provided some idea of possible differences in operative delivery and epidural rates depending on augmentation or not. A sample of 220 women should be large enough to detect moderate changes and will require a 2-year recruitment period. CONCLUSIONS: a subsequent trial is feasible and is now underway. It has the potential to provide information enabling women and practitioners to have a greater choice of care options in the presence of dystocia, or provide a good basis for an even larger trial.

The career paths of nursing graduates from Chelsea College, University of London.

This study aimed to identify the career paths and future career plans of nursing graduates from Chelsea College, University of London. Self-completion questionnaires were sent to the 1981, 1982 and 1983 graduates (N = 54). Employment patterns immediately after and 1, 2 and 3 yr after graduation are described. Most graduates selected careers in nursing, up to 3 yr after graduation. Hospital based clinical posts were most popular and many undertook further clinical courses. The long- and short-term career plans of graduates employed as nurses and those no longer nursing are described. Most graduates indicated that they intended to remain in nursing in the long term.

Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit.

OBJECTIVES: To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit. DESIGN: Randomised controlled trial with six month follow up. SETTING: Urban teaching hospital and surrounding area, including nine community hospitals. PARTICIPANTS: 238 patients accepted for admission to nurse-led unit. INTERVENTIONS: Care in nurse-led unit or usual post-acute care. MAIN OUTCOME MEASURES: Patients' length of stay, functional status, subsequent move to more dependent living arrangement. RESULTS: Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (-3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes. CONCLUSIONS: The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care.

Potential psychological problems of Army Medical Services personnel in combat with particular reference to the Territorial Army.

In the event of a major European war the Army Medical Services (AMS), of whom the majority would be drawn from the Territorial Army (TA), would be exposed to a unique combination of stresses. Ways of reducing the effects of these are discussed.

Advanced psychiatric nursing education in Britain.

This paper examines the British provision for advanced education in psychiatric nursing. Information was derived from a review of the literature, personal contacts with nurse educationalists, and an undergraduate project supervized by the author. After operationally defining advanced education, the paper describes courses at pre- and post-registration levels. These include degree, diploma, clinical, educational and managerial courses. The psychiatric component of nursing degree courses is also considered. Current provision is critically discussed and compared with similar courses for general nurses and educational provision abroad. The paper analyses how and why the current situation has occurred and the effects of current provision on psychiatric nursing practice. The paper concludes with proposals for future developments. These include recommendations for higher education based courses and consideration of a single register of nurses.