Experiences of Teaching and Learning Pediatric Pain Management in Ghana.

BACKGROUND: The literature has revealed gaps in knowledge and attitudes regarding pediatric pain management among Ghanaian nurses and nursing students that can be attributed to inadequate education in the area. Consequently, nursing tutors teaching pain management might not have the appropriate knowledge to transfer to their students. PURPOSE: To explore nursing tutors' experiences of teaching pediatric pain management as well as their students' learning experiences before and after the tutors' training workshop. DESIGN: A descriptive qualitative design was employed for the conduct of the study. METHODS: Data were collected via focus groups from 32 tutors and 24 students before and after an educational workshop. Data analysis drew on Braun and Clarke's thematic analysis. FINDINGS: Pre-workshop themes revealed knowledge deficits regarding pediatric pain management in both tutors and students due to learning having occurred in bits and pieces. Furthermore, lack of accessibility to books and pain scales perpetuated this bits-and-pieces approach to learning. Post-workshop findings revealed gains in tutors' knowledge and skills. Consequently, students gained new insights into pediatric pain management. CONCLUSION: Tutors and student nurses had a knowledge deficit regarding pediatric pain management. The educational workshop and the provision of learning materials resulted in enhanced knowledge and attitudes that subsequently improved tutors' ability to effectively teach the topic to their students, with a clear implication for improvements in clinical practice. CLINICAL IMPLICATION: Educating nursing tutors about pediatric pain is imperative to enable students and thus future nurses to be equipped with the necessary evidence-based knowledge of how to manage pediatric pain.

Exploring factors influencing implementation of interprofessional education in undergraduate healthcare programmes: a multiple-case study.

Interprofessional education (IPE) can help prepare future graduates to work collaboratively in healthcare teams. Using a multiple-case study approach, we explored IPE across four United Kingdom (UK) Higher Education Institutions (HEIs) to identify factors affecting IPE implementation and outcomes. For each site, educators involved with IPE were surveyed and interviewed to explore IPE implementation. To examine outcomes, students took part in focus groups and accreditation reports published by professional regulators were explored. A total of five IPE courses were surveyed, six IPE leads were interviewed, three focus groups were conducted with students, and sixteen reports were reviewed. Regulators' standards mandating IPE and directives by the Deans were the main triggers for IPE initiation. In sites where the regulator's standards were perceived by educators as non-mandating IPE, some staff were less inclined to engage with IPE initiation, which adversely affected IPE planning and delivery. Students from such sites were less satisfied with their IPE experiences and uncertain about the purpose of IPE. Senior management (i.e. Dean) commitment and support is needed to establish IPE initiatives across the institution and cultivate a collaborative culture. The presence of a collaborative culture was associated with positive feedback from regulators and students regarding IPE.

Does Education Improve Nurses' Knowledge, Attitudes, Skills, and Practice in Relation to Pain Management? An Integrative Review.

BACKGROUND: Pain is undertreated in both adults and children and a major factor linked to this is nurses' lack of knowledge as evidenced by studies undertaken globally. OBJECTIVE: This review sought to explore the effects educational interventions can have on nurses' knowledge, attitudes, skills, and practice regarding pain management. DESIGN: An integrative review DATA SOURCES: Systematic search of CINAHL, MEDLINE, AMED, EMBASE, and Psych INFO. REVIEW/ANALYSIS METHODS: Five major databases were systematically searched from the year 2000-December 2019 with a total of 33 studies included in the final review. RESULTS: The literature revealed that many nurses had inadequate knowledge and a poor attitude towards pain at baseline, which may be improved through educational intervention. However, misconceptions remained at post-intervention, particularly regarding pharmacological pain management. CONCLUSIONS: Education is a possible means to enhance nurses' knowledge and improve attitudes and practices in pain management. However, there was some evidence that this may decline over time, and continuous professional updates are likely required.

Are carbohydrate drinks more effective than preoperative fasting: A systematic review of randomised controlled trials.

AIMS AND OBJECTIVES: To evaluate current evidence to determine whether oral preoperative carbohydrate drinks shorten hospital stays, reduce insulin resistance and/or improve postoperative discomfort for patients undergoing abdominal or cardiac surgery. BACKGROUND: Criticisms of standard preoperative fasting have forced practitioners to explore new ways of preparing patients for theatre. Consequently, the use of preoperative carbohydrate drinks prior to elective surgery has gained momentum. Current evidence regarding the efficacy of this treatment has been inconsistent and contradictory which prompted a review of the current literature. DESIGN: A systematic review of randomised clinical trials (RCTs). METHODS: In accordance with Prisma guidelines, the review incorporated a systematic, comprehensive search of English-language-only texts published between 2001-2018. The search focused on five databases (MEDLINE, EMBASE, CINAHL, British Nursing Index and ASSIA). Reference lists of relevant systematic reviews and studies located were also hand-searched for eligibility and further references. All RCTs investigating the effect of preoperative carbohydrate drinks on adult patients undergoing cardiac or abdominal surgery were included. The review excluded RCTs conducted on patients with type 1 or 2 diabetes mellitus and patients under the age of 18. RESULT: The review included 22 RCTs with a total sample of 2,065 patients across thirteen countries. Nine different types of surgery were identified. No significant reductions in hospital stay were noted in 8 of the ten trials. Preoperative carbohydrate drinks significantly reduced insulin resistance and improved postoperative discomfort especially in patients undergoing laparoscopic cholecystectomy. No definite conclusion regarding the impact of preoperative carbohydrate drinks on gastric volume and gastric pH was noted. Similarly, no adverse events such as pulmonary aspiration were reported. CONCLUSION: Preoperative carbohydrate drinks were found to be safe and can be administered up to 2 hr before surgery. Such drinks were also found to reduce insulin resistance and improve postoperative discomfort especially in patients undergoing laparoscopic cholecystectomy. However, there is insufficient evidence to definitively conclude what impact they have on length of hospital stay. RELEVANCE TO CLINICAL PRACTICE: Patients undergoing surgery are often required to fast from midnight, while in some extreme cases patients are fasted for up to 24 hr prior to surgery. The main purpose of asking patients to undergo this prolonged fasting is to reduce the risk of aspiration. However, there is a general consensus that this traditional practice is out of date, and it is often associated with postoperative complications. On the other hand, current evidence suggests oral intake of fluids up to 90-180 min prior to surgery is safe and consumption of a preoperative carbohydrate drinks does not delay gastric emptying or affect gastric acidity.

Exploring UK undergraduate healthcare students' perspectives on how to effectively design IPE: A qualitative study.

Objectives: To explore healthcare undergraduates' views on how to design effective IPE. The need for interprofessional education implementation in undergraduate healthcare education is gaining wide recognition globally. Students' views about their learning experiences can offer useful insights to advance teaching and learning courses. Thus, in the IPE literature, students' views on how to effectively design IPE can help shape future IPE plans. Methods: Purposeful sampling was used to recruit healthcare students who attended IPE events across three UK institutions. Virtual focus groups were conducted, and audio recorded. Transcripts were thematically analysed and relevant themes were presented under three subheadings, pre, during and post IPE session. Results: Twenty-five students from medicine, nursing, pharmacy, midwifery and other disciplines participated in six focus groups. Students thought IPE should be offered consistently across the programme's years of study to ensure learning continuity. Students from programmes with higher placement hours (nursing and midwifery), suggested more IPE in placement. Pre-IPE sessions, introducing IPE to students attending for the first time was perceived to be important as the lack of awareness/understanding of IPE could adversely impact their willingness to attend and their engagement. During IPE, interaction with other students was perceived as the core of an effective IPE session. Students reported difficulties in communication with other students via online IPE sessions and thought they were less engaged compared to face-to-face sessions. Post-IPE, students valued reflective exercises, whereas traditional formal assessment was seen as a barrier to engagement with the learning. Conclusion: Students considered IPE valuable to prepare for future practice. However, students felt that IPE experiences could be enhanced with proper planning to ensure regular compulsory IPE exposure. For better IPE experiences, IPE design and delivery should be in line with each healthcare programme's unique learning and training curriculum.

The impact of education on the knowledge and attitudes of Ghanaian nurse tutors towards the assessment and management of pain in children: A quantitative study.

BACKGROUND: Undertreatment of pain in children is an international problem as many children reports unresolved moderate to severe pain. One key factor which may contribute to under treatment of pain in children by nurses is lack of knowledge. In Ghana opportunities for nurses to learn about pediatric pain have been limited due to gaps in the undergraduate curriculum and inadequate continuing professional education post qualification. OBJECTIVE: To assess tutors' knowledge and attitudes to pediatric pain management before and after an educational workshop. DESIGN: Single group pre-test-post-test design. SETTING: One Ghanaian Nursing Training College. PARTICIPANTS: All (37) nursing tutors in the college. METHOD: Total population sampling was used to access 37 tutors, data were collected using the Knowledge and Attitude Survey Regarding Pain at 3 stages; pre-intervention, immediately after the train-the-trainer based Pediatric Pain Educational Workshop and at 3-months follow-up. Data from the survey were analyzed using descriptive and inferential statistics. RESULTS: Results at pre-intervention showed low scores in the survey. However, post-intervention results at both the immediate and 3-months follow-up stages revealed a significant increase from pre-intervention: Mean (SD) of 20.35 (4.56), to immediate follow-up Mean (SD) 26.93 (5.02), and 3-months follow-up Mean (SD) 25.19 (5.80) and a p-value of <0.001. CONCLUSION: The results suggest tutors' knowledge and attitudes regarding pediatric pain management can be directly improved through a nurse tutor focused educational program. However, knowledge declines with time and as such there is the need for regular update through Continuing Professional Development activities.

Facilitating reproductive choices: the impact of health services on the experiences of young women with breast cancer.

OBJECTIVE: Chemotherapy and hormone treatments carry significant implications on the fertility of young women with breast cancer. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and pregnancy delay. This qualitative study investigated women's responses to being told that treatments affected their fertility and how their interactions with health services impacted on their experiences. METHODS: Twenty-four women under 40 years participated in three focus groups using a flexible interview structure. Data were analysed using content analysis and participants subsequently member checked the themes generated. RESULTS: The priority for most women was survival, although women without children were more willing to take risks. Many women felt that pregnancy after breast cancer and methods of egg harvesting carried a significant risk to survival and fears appeared to be increased by conflicting advice from health professionals. Overall, the women felt the cancer, its treatment options and the health service itself had each robbed them of choice. Hence, with hindsight, many said they would have welcomed an open and honest discussion with a fertility expert to maximise their options. CONCLUSIONS: Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that available options and any potential risks are discussed in a coherent, objective fashion. Early referral to specialist fertility services that provide clear, cohesive advice can aid informed decision making.

Use of indwelling catheters and preventing catheter-associated urinary tract infections.

Indwelling urinary catheters are considered an important healthcare intervention for many patients. However, these devices must be used with caution because they are associated with a risk of various potential complications such as catheter-associated urinary tract infections (CAUTIs), as well as a financial burden for healthcare organisations. This article outlines the various types of indwelling catheter that are available, explains the reasons for their use, and details the care required to prevent associated complications, particularly CAUTIs.

What work do assistant practitioners do and where do they fit in the nursing workforce?

AIM: To understand where assistant practitioners fit in the workforce and examine the roles they are asked to undertake, by comparing their job descriptions with the policy vision. METHOD: A total of 27 job descriptions from three acute trusts were analysed to highlight similarities and differences between the documents. The analysis focused on how clinical tasks related to the level of responsibility APs were expected to assume as part of their role. RESULTS: The analysis revealed the following categories for APs' job descriptions: fully assistive (one description); supportive/assistive (nine); supportive/substitutive (nine); substitutive/autonomous (seven); and fully autonomous (one). This revealed a number of inconsistencies in the form of different organisational expectations about the AP role. CONCLUSION: This study highlights that it is still not clear what managers and workforce planners want from the AP role as it does not have a clearly defined position in the clinical hierarchy, despite being located at level four on the Skills for Health (2006) framework.

Assistant or substitute: exploring the fit between national policy vision and local practice realities of assistant practitioner job descriptions.

OBJECTIVES: To understand the extent to which the assistant practitioner role is described as 'assistive' in formal job descriptions and analyse whether the term 'assistive' has been stretched to encompass more 'substitutive' or 'autonomous' characteristics. METHODS: Sixteen AP job descriptions representing all clinical divisions across one UK acute NHS Hospital Trust were both macro- and micro-analysed for broad similarities and differences in line with Hammersley and Atkinson's analytical framework. The analysis specifically focused on how clinical tasks were related to clinical responsibility, from this the job descriptors were then indexed as belonging to one of five discrete categories. RESULTS: Our analysis revealed the following categories: fully assistive (n=1), supportive/assistive (n=7), supportive/substitutive (n=4), substitutive/autonomous (n=3) and fully autonomous (n=1). From this, a number of anomalies manifest in the form of divergent organisational expectations regarding the AP role. CONCLUSIONS: This study highlights a series of tensions extant between policy vision and implementation of the AP role in practice. Introduction of new healthcare roles requires compromise and negotiation, to shape and define what social space incumbents of these and existing roles will occupy. However the way in which new roles are defined will determine how they become embraced and embedded within future healthcare services.

Mapping the introduction of assistant practitioner roles in acute NHS (hospital) trusts in England.

AIMS: This mapping study describes current or planned introduction of assistant practitioner roles in English National Health Service Acute Hospital Trusts. BACKGROUND: In the last decade there has been a growth in nursing support workforce numbers and their scope of practice. An important United Kingdom support worker development is the Assistant Practitioner role. METHOD: A national census was carried out (April 2007) via an emailed questionnaire to Directors of Nursing. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS: Eighty-five per cent (143/168) of Directors of Nursing, from all 10 English Strategic Health Authorities, responded. Forty-six per cent (n = 66) of Trusts had introduced assistant practitioners and 22% (n = 31) were planning to implement the role before 2009. There is wide variation in assistant practitioner numbers across and between Strategic Health Authorities, Trusts and clinical areas. Resistance to the role existed in 32% (n = 46) of Trusts. Reasons for resistance included no perceived need for the role, lack of evidence of effectiveness, financial constraints and professional and patient safety concerns. IMPLICATIONS FOR NURSING MANAGEMENT: These findings, which contribute to the international evidence-base on health care support workers roles, provide nurse managers with numbers of assistant practitioners and their deployment. This is useful for Nurse Managers making workforce decisions.

International nurses to the rescue: The role and contribution of the nurses of the International Brigades during the Spanish Civil War.

AIM: To describe the life and work of the international nurses of the International Brigades during the Spanish Civil War and to examine their role in relation to their contribution to Spanish nursing in this period. METHODS: This historical study is based primarily on the memoirs of the international nurses who joined the war health services of the International Brigades during the Spanish Civil War. The evidence that was elicited from these sources was compared and contrasted with other contemporary documents in order to compare their perspectives with those of other contemporaries. RESULTS: The nurses of the International Brigades joined the front line health services as part of the mobile medical and surgical teams that were attached to the fighting units. They lived and worked under extreme conditions, often under fire. Their work while in Spain was not limited to care delivery but also included managerial and educational aspects. The international nurses' observations of Spanish nursing at the time were not always accurate, which might be explained by a lack of contact with qualified Spanish nursing staff due to a shortage of fully qualified nurses. CONCLUSION: In the absence of the voices of the Spanish nurses themselves, the written records of the international nurses were invaluable in analyzing Spanish nursing in this period. Their testimonies are, in essence, the international nurses' legacy to the Spanish nurses who stayed behind after the departure of the International Brigadists in 1938.

The potential advantages and disadvantages of introducing interprofessional education into the healthcare curricula in Spain.

The complexity of contemporary clinical practice demands that increasingly skilled high quality health and social care is provided to individuals. However, the failure of health and social care professionals to work collaboratively has been widely reported in the international literature. Hence, interprofessional education has been suggested as a means of improving both interprofessional understanding and respect across a diverse range of practice disciplines. In this way, functional barriers can be challenged or broken down; teamwork enhanced and healthcare outcomes improved. Lack of conclusive evidence to substantiate the above healthcare benefits has been attributed to weak methodological approaches when evaluating such educational initiatives. In Spain barriers to implementing interprofessional education are potentially less challenging. Recent legislative demands following the Bologna Agreement on European Higher Education is compelling Spanish higher education institutes to engage in radical educational reforms. Consequently, this paper examines some of the advantages and disadvantages of introducing interprofessional education into health and social care curricula in Spain to see when and how interprofessional initiatives might be assimilated into the health care curricula. In this way lessons learned from a thorough review of the relevant literature might help to inform such educational reforms across mainland Europe and beyond.

Do MOOCs encourage corporate social responsibility or are they simply a marketing opportunity?

This paper explores institutional drivers for developing MOOCs by juxtaposing them against the original drivers for generating MOOCs: to offer open access education. However, the original impetus for MOOC development may be shifting towards a business oriented model. Therefore, instead of contributing to corporate social responsibility and inclusivity agendas facilitating open access to education, MOOCs are akin to an institution's shop window allowing the pseudo 'purchaser' the opportunity to glimpse behind the scenes. Hence, we ask: are MOOCs merely a sophisticated form of window dressing, showing pseudo 'purchasers' what institutions want them to see enticing them to purchase more lucrative products? Notwithstanding the motivation for developing MOOCs participants must first access them. Therefore the paper examines what MOOCs actually offer participants who are likely to access them and concludes by examining how MOOCs can be developed to facilitate better completion rates and encourage wider participation from hard to access groups.

Gene arrays at Pneumocystis carinii telomeres.

In the fungus Pneumocystis carinii, at least three gene families (PRT1, MSR, and MSG) have the potential to generate high-frequency antigenic variation, which is likely to be a strategy by which this parasitic fungus is able to prolong its survival in the rat lung. Members of these gene families are clustered at chromosome termini, a location that fosters recombination, which has been implicated in selective expression of MSG genes. To gain insight into the architecture, evolution, and regulation of these gene clusters, six telomeric segments of the genome were sequenced. Each of the segments began with one or more unique genes, after which were members of different gene families, arranged in a head-to-tail array. The three-gene repeat PRT1-MSR-MSG was common, suggesting that duplications of these repeats have contributed to expansion of all three families. However, members of a gene family in an array were no more similar to one another than to members in other arrays, indicating rapid divergence after duplication. The intergenic spacers were more conserved than the genes and contained sequence motifs also present in subtelomeres, which in other species have been implicated in gene expression and recombination. Long mononucleotide tracts were present in some MSR genes. These unstable sequences can be expected to suffer frequent frameshift mutations, providing P. carinii with another mechanism to generate antigen variation.

Breaking bad news: qualitative evaluation of an interprofessional learning opportunity.

This paper analyses the effects of bringing together a small group of nursing and medical students to learn the skills needed to break bad news to patients. It outlines the qualitative and quantitative methods used, to provide the reader with a comprehensive account of the teaching, learning and research strategies drawn on during the study. The paper examines the evaluation phase, as this aspect is of greatest import if such initiatives are to flourish. The facet of the study analysed in detail concerns the students' responses to the open-ended qualitative questionnaires. In coding the data, three researchers independently highlighted a series of themes associated with the benefits and hazards of nursing and medical students learning and working together. Finally, the paper closes by arguing that trust and mutual respect are vital ingredients if collaborative working is to become part of the medical and nursing curriculum.

Isolates of Pneumocystis jirovecii from Harare show high genotypic similarity to isolates from London at the superoxide dismutase locus.

Pneumocystis jirovecii is the cause of Pneumocystis pneumonia (PCP) in humans. Isolates of P. jirovecii obtained from patients in Harare, Zimbabwe were genotyped at the superoxide dismutase locus. High genotypic similarity to isolates of P. jirovecii obtained from patients in London, UK was observed. These data provide additional support for the hypothesis that P. jirovecii is genetically indistinguishable in isolates from geographically diverse locations.

Patient safety: do nursing and medical curricula address this theme?

In this literature review, we examine to what extent patient safety is addressed within medical and nursing curricula. Patient safety is the foundation of healthcare practice and education both in the UK and internationally. Recent research and policy initiatives have highlighted this issue. The paper highlights the significance of this topic as an aspect of study in its own right by examining not only the fiscal but also the human costs such events invite. In the United Kingdom patient safety issues feature prominently in the (Department of Health, 2000a. An organisation with a memory. The report of an expert group on learning from adverse events. The Stationery Office, London, Department of Health, 2000b. Handling complaints: monitoring the NHS complaints procedures (England, Financial year 1998-99). The Stationery Office, London.) policy documentation but this is not reflected within the formal curricula guidelines issued by the NMC and GMC. Yet if healthcare educational curricula were to recognise the value of learning from errors, such events could become part of a wider educational resource enabling both students and facilitators to prevent threats to patient safety. For this reason, the paper attempts to articulate why patient safety should be afforded greater prominence within medical and nursing curricula. We argue that learning how to manage errors effectively would enable trainee practitioners to improve patient care, reduce the burden on an overstretched health care system and engage in dynamic as opposed to defensive practice.

Synthesising the literature as part of a literature review.

This article examines how to synthesise and critique research literature. To place the process of synthesising the research literature into context, the article explores the critiquing process by breaking it down into seven sequential steps. The article explains how and why these steps need to be kept in mind if a robust comprehensive literature search and analysis are to be achieved. The article outlines how to engage in the critiquing process and explains how the literature review needs to be assembled to generate a logical and reasoned debate to examine a topic of interest or research in more detail.

Oropharyngeal samples for genotyping and monitoring response to treatment in AIDS patients with Pneumocystis carinii pneumonia.

A nested PCR, amplifying a portion of the gene encoding the mitochondrial large subunit ribosomal RNA (mt LSU rRNA) of Pneumocystis carinii sp. f. hominis was applied to oropharyngeal samples obtained on repeated occasions from 12 HIV-infected patients with P. carinii pneumonia (PCP) to monitor response to anti-P. carinii treatment. Genotyping of P. carinii sp. f. hominis was also performed on paired samples of oropharyngeal and broncho-alveolar lavage samples before the start of treatment, and on oropharyngeal samples during the course of treatment, by analysis of sequence variation at the internal transcribed spacer (ITS) regions of the nuclear rRNA operon. When a simple dilutional method was used, a reduction in the amount of amplification product was observed in samples from all patients during the course of treatment. In eight of the 12 patients, a single ITS sequence type was found in the oropharyngeal samples and also in the paired broncho-alveolar lavage sample. A mixed infection was identified in the samples from three patients. In eight patients, the ITS sequence types identified in the oropharyngeal sample were the same as in the broncho-alveolar lavage sample. Nested PCR amplifying the mt LSU rRNA on oropharyngeal samples provides a non-invasive method of monitoring response to treatment of PCP. ITS sequence typing of P. carinii sp. f. hominis from oropharyngeal samples appears to be a reliable alternative to broncho-alveolar lavage samples and provides a non-invasive tool for further epidemiological studies.