The views of patients, mentors and adult field nursing students on patients' participation in student nurse assessment in practice.

In recent years, changes to undergraduate nursing curricula in the United Kingdom have been coupled with increasing expectations that service users be involved in assessment of student nurses. These factors lead to the development of a tool to facilitate gathering of feedback from patients/carers on the competency of adult field student nurses in practice. This study evaluated experiences of those involved in the process of using the feedback tool. Using an exploratory qualitative research design, four patients, four mentors and five pre-registration adult field nursing students were interviewed. Thematic analysis of the data identified three interconnecting themes; value of the patient's voice, caring and protection, and authenticity of feedback. A sub-theme of timing of giving feedback was also identified. Patients felt they should be involved in giving feedback, were comfortable in doing so, and felt best placed to judge students' performance in several aspects of care. Students and mentors shared these opinions. Additionally they felt service user feedback potentially helped improve students' competence and confidence, and facilitated mentors in their assessment of students' professional values, communication and interpersonal skills. However, mentors were more reticent about the possibility of receiving feedback from service users on their own practice.

Genome Sequences of Pseudoalteromonas Strains ATCC BAA-314, ATCC 70018, and ATCC 70019.

The assembly and annotation of the draft genome sequences for Pseudoalteromonas strains ATCC BAA314, ATCC 700518, and ATCC 700519 reveal candidates for promoting symbiosis between Pseudoalteromonas strains and eukaryotes. Groups of genes generally associated with virulence are present in all three strains, suggesting that these bacteria may be pathogenic under specific circumstances.

A seven-day diabetes service for inpatients and the emergency department in an acute hospital setting - the East and North Herts Diabetes Outreach Team (DOT).

There is evidence that all hospital-based care needs to improve across 7 days. Inpatients with diabetes require better specialist attention and improved clinical outcomes. The East and North Herts inpatient diabetes service has responded to this challenge with care now delivered by consultants and diabetes nurses, 365 days per year. We set out to provide a prospectively measurable improvement in ascertainment of appropriate patients alongside a 'care bundle' to ensure they receive a better quality experience. We also set out to document quantifiable changes in clinical data. A seven-day service is now in place and provides a variety of benefits to both professionals and patients alike.

A 'roll-on, roll-off' preceptorship pathway for new registrants.

The need to support high numbers of new registrants simultaneously at the Royal United Hospital, Bath, led to the development of a preceptorship pathway. The 'roll-on, roll-off' structure allows newly registered nurses and allied health professionals to start preceptorship as soon as they take up their roles. Essential competencies are negotiated with managers and achieved through subject-focused teaching sessions, workplace preceptorship, reflection, peer support and the use of distance-learning materials that link to the NHS knowledge and skills framework and appraisal requirements. Evaluation suggests that the pathway provides a high standard of learning and support, but development will continue, particularly in relation to monitoring and recording new practitioners' involvement in clinical incidents and their completion rates.

Community matrons--an exploratory study of patients' views and experiences.

AIM: The aim of the study was to explore patients' views and experiences of the community matron role in one primary care provider organization. BACKGROUND: Community matrons manage the needs of people living with long-term conditions in the community and aim to improve patient self-management and education, and enhance co-ordination between in primary and social care. METHODS: A purposive sample of 14 service users (ten women, four men; aged 45-89 years) with a range of chronic conditions took part in interviews in 2007. A grounded theory approach was the framework for data collection and analysis. FINDINGS: The role of the community matron appeared to have a positive impact on patient care mainly in three areas: access, patient advocacy and psychosocial support. Patients thought that they had easier access to healthcare services and that the community matron acted as an advocate by helping them to understand medical jargon and supporting them at hospital appointments, thereby providing a link to secondary care. Some patient perceptions differed from those about other primary care staff. CONCLUSION: There is evidence that community matrons may have a beneficial effect on patients' perceptions of their care, psycho-social support, access to services and advocacy. The impact of this role on the patient experience needs to be taken into account when evaluating this nursing role and services, as benefits may not be captured by relying solely on quantitative evaluations of hospital readmission rates.

Using supported learning to ensure nurse recruits are skilled to care for acutely ill patients.

Recruiting registered nurses to acute care wards can be difficult as applicants often lack the necessary skills to work with acutely ill patients. To overcome this problem the Royal United Hospital Bath Trust set up an acute care training programme. Through partnership working between managers, clinical, education and human resource staff, it provides an opportunity for nurses to develop confidence and competence to meet the needs of the acutely ill.

Community matrons: primary care professionals' views and experiences.

AIM: This article is a report of a study exploring how the role of the community matron is progressing and any barriers or facilitators to performing the role. BACKGROUND: Long-term conditions are distressing for patients and costly for healthcare services. Government policy in western countries has increasingly focussed on more integrated and pro-active management of patients with multiple long-term conditions to maintain the ability of the aging population to function independently. The role of community matrons has been introduced in England in an attempt to address these issues. METHOD: A purposive sample of 31 health and social care professionals participated in five focus group discussions. Reported experiences of the community matron role by community matrons, district nurses, social workers and general practitioners were analysed according to the principles of grounded theory. Data were collected in 2007. FINDINGS: The community matron role was seen as effective in meeting the medical and social needs of patients. This was achieved through patient education, developing patients' self-management of their health conditions and monitoring their social needs. Potential barriers to success of the role were associated with lack of role definition prior to its introduction. CONCLUSION: It is unclear whether the role is financially viable in its current form. Further research is required to examine differing models for implementing the role and judging its effectiveness in bridging the primary-secondary care interface.

The implementation and evaluation of an oral healthcare best practice guideline in a paediatric hospital.

The oral health of the New Zealand population now compares unfavourably with other countries. A number of strategies have been introduced at a government and health provider level to improve the oral health status of children. One such strategy was the introduction of a recommended best practice (RBP) within Starship Children's Hospital. Nursing practice was evaluated 2 weeks prior and 6 months post-implementation of the RBP using a survey technique. While there was no significant change in practice post-introduction of the RBP, awareness regarding the oral health care needs of children while in hospital has been improved. This study provides increased understanding in regard to the oral healthcare practices of paediatric nurses, the influences on evidence-based practice change and health education and promotion within an acute paediatric hospital.

Improving patient care through work-based learning.

AIM: To record post-registration community nurses' perceptions of the impact of work-based learning on the quality of patient care. METHOD: Ten nurses were interviewed. Each interviewee, who had successfully completed work-based learning programmes, was asked to describe their impact on the quality of patient care. FINDINGS: The participants valued work-based learning. Four themes emerged where work-based learning contributed to improving the quality of care: increased health promotion, increased access to services, increased patient choice and reduced risk of infection. The relevance of studies and distance learning materials were perceived to be the main aspects that influenced changes in practice. CONCLUSION: The study provides insight into how work-based learning helped staff develop practice. It highlights that time for learning and mentoring are paramount for changes in practice to occur through work-based learning. Further studies are required to establish the best structure and style of distance learning materials needed to meet the needs of post-registration community nurses.

Posttraumatic stress symptoms in children after mild to moderate pediatric trauma: a longitudinal examination of symptom prevalence, correlates, and parent-child symptom reporting.

BACKGROUND: Full recovery from injury may be hindered by both physical ailments and psychologic distress. Little information is available on the psychologic response of children to physical trauma, although long-term dysfunction may result if psychologic needs are not identified and addressed. This study examined the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms in children and adolescents after an acute traumatic event resulting in mild to moderate physical injury. We were also interested in analyzing the discrepancies between parent/child reporting of the child's PTSD symptomatology. Because of the paucity of research evaluating interventions for pediatric PTSD, and as a secondary objective for this study, we collected preliminary data on the effectiveness of a single-session art therapy intervention designed to reduce PTSD symptoms. METHOD: From July 1998 through October 2000, 83 children/adolescents between the ages of 7 and 17 and their caregivers were interviewed within 24 hours of hospital admission and assessed for PTSD symptomatology, trauma history, and other measures of child and family functioning. Interviews were repeated at 1 month, 6 months, and 18 months after the initial hospitalization. Patients with at least mild symptomatology at the initial interview were randomized to receive either an art therapy intervention or standard hospital services alone. RESULTS: A total of 69% of children were found to have at least mild PTSD symptoms at baseline, 57% at 1 month, 59% at 6 months, and 38% at 18 months postinjury. Younger age and the severity of parental PTSD symptoms were correlated with symptom presence in children. Parents initially underreported their child's symptom severity when compared with the child's report, but assessments converged over time. The art therapy intervention showed no sustained effects on the reduction of PTSD symptoms. CONCLUSION: The presence of PTSD symptoms in children after traumatic injury is very high. Parental distress and characteristics of the family environment appear to be more relevant to the presence of child symptoms than the family make-up, course of hospitalization, or extent of the child's injuries. Parents may not initially recognize the degree to which their children experience such symptoms. The high presence of symptoms in this population underscores the need for treatment efficacy studies and parent/medical staff education in identification of PTSD.

Work-based learning: making a difference in practice.

Nurses play an increasingly crucial role in ensuring that patients receive the best possible care, and strive to lead innovations in health care. Changing practice is not easy and many nurses do not have the leadership skills or confidence to push for change. Therefore, they need to know that they are supported and encouraged to bring about change in nursing practice. Primary care trusts in the west of Berkshire and a university based in Reading have worked together to respond to this challenge by developing and implementing a flexible, accredited, work-based educational programme. The programme ensures that patients remain at the heart of learning by enabling nurses to lead and influence practice.

Purification and characterization of a recombinant alpha-N-acetylgalactosaminidase from Clostridium perfringens.

Clostridium perfringens alpha-N-acetylgalactosaminidase (alphaNAG) hydrolyzed the terminal N-acetyl-alpha-d-galactosamine from the blood type A(2) antigen producing H antigen, blood type O. Blood type O is universally compatible in the ABO system. Purification of the native enzyme is difficult with very low yields. To obtain the enzyme in satisfactory yield, the gene encoding the clostridial enzyme was cloned in an Escherichia coli T7 expression system. A highly purified preparation of recombinant alphaNAG was obtained from cell lysates by ion-exchange chromatography and high-pressure liquid chromatography. The final preparation was homogeneous by SDS-PAGE with a molecular mass of 71.96kDa and the native molecular weight of 72.42kDa. The enzyme was highly selective for terminal N-acetylgalactosamine residues. No other significant exoglycosidase activities, particularly neuraminidase, were detected. The pH optimum of the enzyme was between 6.5 and 7.0 and activity was relatively unaffected by ionic strength. ELISA experiments demonstrated activity against blood type A(2) epitope. These characteristics were similar to those of native alphaNAG from C. perfringens. With adequate expression in E. coli, sufficient recombinant alphaNAG enzyme mass can be obtained for potential use in enzymatic conversion of human blood type A(2) red blood cells to universally transfusable type O red blood cells.

Identification, molecular cloning and expression of an alpha-N-acetylgalactosaminidase gene from Clostridium perfringens.

The Clostridium perfringens gene encoding the previously characterized alpha-N-acetylgalactosaminidase (alphaNAG) was identified by protein microsequencing and database searching. The alphaNAG protein, designated AagA, was found to be encoded by a hypothetical gene of unknown function in the recently completed genome sequence of C. perfringens strain 13. The deduced translation product of 629 amino acid residues possessed a region of limited homology to several hypothetical open reading frames, an enterotoxin of unknown function and several known or predicted alpha-galactosidases, but did not exhibit homology to any of the multiple sequenced eukaryotic alphaNAG proteins. The C. perfringens aagA gene, encoding AagA, was cloned in an Escherichia coli T7 expression system, resulting in recombinants exhibiting high-level expression of the expected alphaNAG activity. To our knowledge, this is the first report of the cloning and expression of a bacterial alphaNAG-encoding gene and represents an important step in the development of recombinant alphaNAG as a tool in the enzymatic conversion of blood group antigens.

Developing a learing culture.

A KEY ELEMENT to retaining and recruiting a nursing workforce is making sure that nurses are empowered to develop their practice and that they know their managers and other health professionals value their work. Although patients and relatives may well be effusive in their thanks to nurses, which in itself is an important aspect for job satisfaction, it is not enough.