Addressing patient sexuality issues in cancer and palliative care.

The impact of cancer and subsequent treatments can have serious implications for patient sexuality, both physically and psychologically. Patients report inadequate communication and support from professionals in relation to sexual issues. The aim of this literature review was to ascertain the educational requirements of health professionals practising in oncology and palliative care, to enable effective assessment and support in this area of clinical practice. There appear to be numerous barriers preventing professionals from addressing patient sexuality-lack of knowledge and poor confidence levels being among the most common. Appropriate education is required to equip staff, and it appears that short training programmes can be effective. The use of sexuality assessment tools and information cards, and accessing information from cancer charity websites may improve clinical practice. Addressing sexuality concerns is the responsibility of each person in the multidisciplinary team. Patients require open discussion and professionals must skilfully address the topic of sexuality. Education in this area must be accessible, cost effective and sustainable.

An audit of the British Thoracic Society asthma discharge care bundle in a teaching hospital.

BACKGROUND: The UK asthma mortality rate has risen by 33% over a decade. The national enquiry into 195 asthma-related deaths revealed that most of these deaths were preventable. The Asthma Discharge Care Bundle (ADCB) is recommended for use when discharging patients with an acute asthma attack and/or exacerbation. AIM: To review the implementation of the British Thoracic Society (BTS) bundle in a teaching hospital. METHODS: A 12-month retrospective audit was conducted on 86 adult patients treated for asthma attacks. FINDINGS: The results of the audit indicated that the hospital has complied with the ADCB. In total, 85% of patients had their inhaler technique checked, but 62% of them were not provided with any written inhaler use instructions. The respiratory clinical nurse specialists were more compliant with most of the bundle statements than the medical team. CONCLUSION: The findings highlighted the need for asthma education sessions for all health professionals with emphasis on record-keeping skills.

Renal inpatient ward nurse experience and job satisfaction: A qualitative study.

AIMS AND OBJECTIVES: To examine the experience of registered nurses working in renal inpatients wards at an acute National Health Service (NHS) hospital Trust. Nurse perceptions of their experience particularly in relation to job satisfaction were analysed. BACKGROUND: Increased understanding of workplace organisation and culture can contribute to improved nurse work experience and better patient care. Worldwide many studies conducted on nurse experience and job satisfaction show that job satisfaction level varies across work settings so analysis of job satisfaction at a local level such as in a ward is important for producing useful analysis and recommendations. METHOD: Using purposive sampling, semistructured individual interviews were conducted on twelve registered nurses working on renal inpatient wards. RESULTS: The study identified three themes: safe care, organisational culture and work environment. Although staffing was identified as a key element to providing safe care maintaining adequate staffing levels remained a challenge. Whilst there were opportunities for professional development more support is needed for newly qualified nurses. CONCLUSIONS: Findings highlighted that renal patients were complex. It is important to maintain adequate staffing levels. Good clinical leadership is required to support and develop the positive experience of nurses. RELEVANCE TO CLINICAL PRACTICE: The high turnover of newly qualified nurses is a particular problem and nurse managers need to develop strategies to retain such nurses. Regular audits on staffing levels as part of improving workforce planning and patient safety need to be conducted.

The views of older people and health professionals about dignity in acute hospital care.

AIMS AND OBJECTIVES: To report the findings from interviews conducted as part of a wider study on interventions to support dignified care in older people in acute hospital care. The data in this study present the interview data. BACKGROUND: Dignity is a complex concept. Despite a plethora of recommendations on how to achieve dignified care, it remains unclear how to attain this in practice and what the priorities of patients and staff are in relation to dignity. DESIGN: A purposive sample of older patients and staff took part in semi-structured interviews and gave their insight on the meaning of dignity and examples of what sustains and breaches a patient's dignity in acute hospital care. METHOD: Thirteen patients and 38 healthcare professionals in a single metropolitan hospital in the UK interviewed. Interviews were transcribed verbatim and underwent a thematic analysis. RESULTS: The meaning of dignity was broadly agreed on by patients and staff. Three broad themes were identified: the meaning of dignity, staffing level and its impact on dignity, and organisational culture and dignity. Registered staff of all healthcare discipline and student nurses report very little training on dignity or care of the older person. CONCLUSION: There remain inconsistencies in the application of dignified care. Staff behaviour, a lack of training and the organisational processes continue to result in breaches to dignity of older people. Clinical nurses have a major role in ensuring dignified care for older people in hospital. RELEVANCE TO CLINICAL PRACTICE: There needs to be systematic dignity-related training with regular refreshers. This education coupled with measures to change the cultural attitudes in an organisation towards older peoples' care should result in long-term improvements in the level of dignified care. Hospital managers have an important role in changing system to ensure that staff deliver the levels of care they aspire to.

Development of tools to measure dignity for older people in acute hospitals.

BACKGROUND: Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end-of-life care. No tools for measuring dignity in acute hospital care have been reported. OBJECTIVES: To develop tools for measuring patient dignity in acute hospitals. SETTING: A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above. METHODS: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6-24); a format for nonparticipant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere). RESULTS: A total of 5,693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p < 0.001). Staff-patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%-59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%-48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)-63% (longer interactions) (F[2, 557] = 28.67, p < 0.001). CONCLUSIONS: We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive.

Systematic review: what interventions improve dignity for older patients in hospital?

AIMS AND OBJECTIVES: To review the evidence for interventions to improve dignity for older patients in acute care. BACKGROUND: High profile cases have highlighted failure to provide dignified care for older people in hospitals. There is good evidence on what older people consider is important for dignified care and abundant recommendations on improving dignity, but it is unclear which interventions are effective. DESIGN: Narrative systematic review. METHODS: The Cochrane library, MEDLINE, EMBASE, CINAHL, BNI and HMIC electronic databases were searched for intervention studies of any design aiming to improve inpatients' dignity. The main population of interest was older patients, but the search included all patients. Studies that focused on 'dignity therapy' were excluded. RESULTS: There were no intervention studies found in any country which aimed to improve patient dignity in hospitals which included evaluation of the effect. A narrative overview of papers that described implementing dignity interventions in practice but included no formal evaluation was, therefore, undertaken. Five papers were identified. Three themes were identified: knowing the person; partnership between older people and health care professionals; and, effective communication and clinical leadership. The effect on dignity of improving these is untested. CONCLUSIONS: There are currently no studies that have tested interventions to improve the dignity of older people (nor anyone else) in hospitals. Further research using well designed trials of interventions is needed. There is also a need to develop and validate outcome measures for interventions to improve dignity. RELEVANCE TO CLINICAL PRACTICE: At present nurses lack robust evidence on how to improve dignity. There is ample evidence on what undermines patients' dignity and there is a need to develop and test interventions designed to improve patient dignity.

Renal nurses' experiences of patients with severe mental health conditions receiving acute haemodialysis: A qualitative study.

BACKGROUND: Patients receiving acute haemodialysis treatment and living with severe mental illness may display behaviours that are perceived as challenging and stressful for renal nurses to manage in the acute haemodialysis unit. Renal nurses are historically trained on the technical aspects of acute haemodialysis and can provide a level of psychological support to patients. However, they have not been trained to manage patients with severe mental illness. OBJECTIVE: To explore renal nurses' experiences of nursing patients with severe mental illness receiving acute haemodialysis, and to identify factors that facilitate or hinder the nursing care of these patients. DESIGN: A descriptive qualitative study. METHOD: Purposive sampling was employed, and semi-structured interviews were conducted with 10 renal nurses working in an acute haemodialysis unit. Thematic analysis was utilised to analyse the data. FINDINGS: Thematic analysis identified four main themes which are perspectives of mental Illness, patient and staff safety concerns, facilitators of care and education and support needs. CONCLUSION: Renal nurses experienced difficulty managing challenging behaviours manifested by patients with severe mental illness. Despite the various challenges, renal nurses adopted a person-centred approach. Staff shortages and lack of training were significant hindrances to care delivery. Education on mental health conditions, support from senior staff and collaborative working can enable confidence and increase renal nurses' knowledge and experience in mental health care.

An evaluation of nurses' clinical teaching role in Turkey.

A study of 91 nurses in Hacettepe University Adult Hospital in Turkey investigated how effective clinical nursing teaching was and analyzed the reasons for their teaching performance. Questionnaires about patient care, management, research, and teaching role were administered to the nurses in the study. The results of the questionnaires were expressed in numerical and percentage terms. Nurses were most effective in providing the patient care materials and equipment requested by students, helping students to adjust to a clinical environment and regarding students as team members. In contrast, nurses were least effective at discussing patients with students and at evaluating the patient care provided by students. The reasons that nurses gave for their clinical teaching performance were those of being overloaded with work, adhering to the view that teaching is not a nursing role, suffering from a lack of equipment, and the problem of students working slowly and hence wasting nurses' time. The nurses' recommendations for improving clinical teaching performance were those of increasing the co-operation between nursing schools and hospitals, the introduction of clinical nurse specialists, placing more emphasis on clinical teaching in nursing education and providing training courses on clinical teaching.

The physical, social and psychological impact of priapism on adult males with sickle cell disorder.

Priapism is defined as prolonged and painful penile erection that does not subside on orgasm. It is considered to be a urological emergency. However, patients do not always seek prompt medical help. The incidence of priapism is increased by sickle cell disease, where it is a complication of the characteristic sickling of the red blood cells. Little is known about the psychological or social implications of this complication or the strategies that sickle cell patients use to manage it. A qualitative study was carried out in order to investigate these topics. Semi-structured interviews were carried out with adult male patients of the Sickle Cell and Thalassaemia Centre in Birmingham in the UK who experienced priapism. These were subsequently analysed using grounded theory. Ten themes were elicited: first occurrence of priapism, pain, precipitants, emotional consequences, self-management, experience of hospital, impact on work and social life, impact on sexual relationships, erectile dysfunction, and disclosure. The dominant experiences were ones of despair, embarrassment, and isolation. Participants described finding it difficult to disclose priapism, with the result that it was often unreported until late in its course. Attempts to manage priapism at home varied, with there being little consensus on their efficacy. The results are discussed with respect to the healthcare services that cater for these patients.