Family-witnessed resuscitation in the emergency department in a low-income country.

Cardiac arrest is often a sudden and traumatic event. Family-witnessed resuscitation was first recommended by the American Heart Association over two decades ago. Since then several global professional bodies have identified a range of potential benefits for relatives; however, it remains contentious. For nurses working in emergency departments (EDs) in low-income countries, the evidence for, and experience of, family-witnessed resuscitation is limited. This article critically appraises the literature relating to the perceptions of medical professionals and critically ill patients and their families about communication, family presence and their involvement during resuscitation in the ED. Three themes relating to family-witnessed resuscitation in the ED were identified by a focused literature search. These were: leadership and communication, limitation of policies and guidelines and relatives' views. The recommendations from this review will be used to develop emergency and trauma nursing practice guidelines in Zambia, a low-income country in sub-Saharan Africa.

Undertaking a neurological assessment.

Neurological observations are an essential aspect of assessment in patients with altered mental status and require the nurse to collect and analyse information using a validated assessment tool. Assessing a patient's pupil size and response is also an important element of a neurological assessment. This article summarises the pathophysiology of raised intracranial pressure and lists some of the conditions that may contribute to an alteration in a patient's mental status. The article details the use of two commonly used neurological assessment tools and the assessment of a patient's pupil size and response. The author also considers the challenges related to accurate recording of neurological observations.

Nurses' wound care competency in a sample of hospitals in Northern Vietnam.

BACKGROUND: This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses. METHODS: A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care. RESULTS: A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans. CONCLUSIONS AND RECOMMENDATIONS: The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.

Evaluation of an international health partnership to capacity build emergency, trauma and critical care nurse education and practice in Zambia: An experience from the field.

AIM: To evaluate an international health partnership project to capacity build emergency, trauma and critical care nurse education and practice in Zambia. BACKGROUND: Zambia continues to face a significant workforce challenge and rising burden of communicable and non-communicable diseases, compounded by the COVID-19 pandemic. In response to these, the Zambian Ministry of Health is investing in specialised nurses. Emergency, trauma and critical care nursing education and training were seen as one of the solutions. North-south partnerships have been identified as a force for good to capacity build and develop emerging specialities. SOURCES OF EVIDENCE: We use an evaluative approach, which includes desk research, a rapid literature review and documentary data analysis from published papers, government reports and project documentation. Ethics committee approval was sought and gained in both Zambia and the UK. DISCUSSION: A critical review of the evidence identified three key themes: challenges with changing education and practice, developing Zambian faculty for sustainability and the effect of an international health partnership project on both Zambia and UK. The outcomes from this project are multifaceted; however, the main achievement has been the implementation of emergency, trauma and critical care graduate programmes by the Zambian faculty. CONCLUSION: This experience from the field outlines the benefits and limitations of a north-south partnership and the importance of transparency, shared ownership and collegiate decisions. It has facilitated knowledge exchange and sharing to capacity build emergency, trauma and critical care nursing. IMPLICATIONS FOR NURSING PRACTICE: Lessons learned may be applicable to other international nursing partnerships, these include the need for deep understanding of the context and constraints. Also, the importance of focusing on developing long-term sustainable strategies, based on research, education and practice was noted. IMPLICATIONS FOR NURSING POLICY: This paper outlines the importance of developing nursing education and practice to address the changing burden of disease in line with Zambian national policy, regional and international standards. Also, the value of international nursing partnerships for national and international nursing agendas was described.

Review of enteral nutrition practices in critically ill adults in resource-limited environments.

Enteral nutrition in critical care is a complex area of practice. A resource-limited environment includes countries that are identified as low income and low/middle income. This review describes three themes for its successful implementation of enteral nutrition in a resource-limited environment. These include identification of patients at risk of malnutrition, using non-commercial feeds and the urgent need to develop practice. Malnutrition is a serious complication of critical illness and remains a crucial aspect of patient care in order to prevent complications. Further evidence to develop sustainable enteral nutrition strategies for critically ill patients is urgently required. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Service evaluation of a COVID-19 critical care orientation programme.

BACKGROUND: During the first wave of the COVID-19 pandemic in the UK, south London had the highest number of COVID-19 patients admitted to critical care. At one hospital, staff being redeployed to critical care were invited to attend an orientation to critical care workshop. AIM: To carry out a service evaluation of the training outcomes from rapidly redeployed staff who completed the workshop during the first wave of the COVID-19 pandemic (March-July 2020). METHODS: Two stages were used, the first was a post-workshop evaluation questionnaire completed immediately after the training, with the second involving a single centre e-survey questionnaire two months later. FINDINGS: In total 131 health professionals attended the workshop, and 124 (95%) post-course evaluations were completed. Some 116 staff were contacted for the e-survey, with a response rate of 34% (n=40). Overall, the training was well evaluated. Of the 40 respondents, 70% (n=28) had volunteered, but only just over half (n=21, 52%) went on to work in critical care. CONCLUSION: This article describes the organisational response of one NHS acute hospital to the unprecedented challenges that arose from the COVID-19 pandemic. The service evaluation identified the importance of a pedagogical approach, which not only delivered clinical content, but also allayed anxiety for health professionals preparing to work in a new environment.

The 'sleeping elephant': The role of mentorship of critical care nurses in Zambia.

AIM: To develop and evaluate a Zambian context-specific mentorship model that supports registered nurses completing emergency, trauma and critical care programmes in Zambia. BACKGROUND: In Zambia, emergency and trauma and critical care nursing are relatively new specialties, with education and training programmes less than a decade old. A train the trainer mentorship programme was developed and delivered at two colleges of nursing. Ethics approval was gained in both Zambia and the UK. SOURCES OF EVIDENCE: Documentary data analysis and focus groups were used. Focus groups included stakeholders and nurses in practice who had completed the train the trainer programme and were using the mentorship model. DISCUSSION: The critical review of the literature revealed there was a paucity of evidence on the role of mentors in critical care. However, national documentation identified that most post basic education programmes are at Diploma Level with limited content that focuses on bedside teaching, mentorship and assessment content. CONCLUSION: Feedback from representatives attending the stakeholder workshops and focus groups which included participants who had completed the training programme enabled the mentorship model and workshop to be developed and evaluated. IMPLICATIONS FOR NURSING PRACTICE: Nurses are the backbone of healthcare systems in Africa and the world. Mentorship and assessment in practice enables nurses to develop the competence and skills to lead practice, support peers and junior colleagues. IMPLICATIONS FOR NURSING POLICY: This paper has identified the need for a context-specific formalised mentorship model to support specialist practice and this project has provided the foundations for mentorship of emergency, trauma and critical care nurses in Zambia.

Psychological issues affecting patients living with a stoma.

Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.

The development of critical care nursing education in Zambia.

BACKGROUND: Critical care services reflect the healthcare services they support. In many low-to-middle-income countries (LMICs), balancing a sparse workforce, resources and competing demands to fund services, is a significant challenge when providing critical care. In Zambia, critical care has evolved significantly over the past 10 years. This article explores the provision of critical care services and the review and validation of a critical care nursing course. OBJECTIVES: To review the literature relating to critical care nursing in sub-Saharan Africa to support a review and validation of the current critical care nursing course and to prepare a framework for a Bachelor of Science (BSc) in critical care nursing programme in Zambia. RESULTS: A search of the published literature identified key themes, including a paucity of evidence, limited educational opportunities, a lack of national and international opportunities, protocols and standards, and the challenges of providing technical services. The subsequent review and validation took account of these themes. CONCLUSION: This project has had an impact on improving critical care nurses' knowledge and skills and provided the foundations for the BSc in critical care nursing.

'I'll never be the same': the impact of an international elective.

BACKGROUND:: many undergraduate student nurses have the opportunity to undertake an international elective-that is, a placement in another country. The benefits of undertaking an elective include developing cultural competence, understanding different healthcare systems and experiencing a different culture. AIM:: the aim of the study was to evaluate the impact of a faculty-structured international travel elective to Zambia for undergraduate UK nursing students. METHODS:: a descriptive phenomenology approach was used to discover and explore the students' experiences of their elective. FINDINGS:: 6 students participated in semi-structured interviews. Themes that emerged included the importance of preparing for the elective, different nursing cultures, realities and patient safety concerns. CONCLUSION:: this study found that students involved in an international elective to Zambia overall had a positive experience but did report some challenges; the findings contribute to the body of evidence relating to international electives.

Evaluating a training programme at Viet Duc University Hospital in Vietnam.

UNLABELLED: Vietnam's nursing competency standards (VNCS) were issued in 2012 as the legal framework on which the continuous nursing training programme are designed and developed. OBJECTIVES: The study aimed to assess the knowledge, skills, and attitudes as well as the confidence of nurses regarding wound care at Viet Duc University Hospital before and after a new educational intervention. METHOD: A comparative descriptive study was carried out in 2014 at Viet Duc University Hospital. The study reviewed knowledge, skills, attitude and confidence among nurses working in seven clinical departments. The data collection tools included a 48-knowledge-item self-administered questionnaire, a sixteen-item skills set, and attitude-item observation sheet and a thirteen confidence level-item observation sheet, adapted for the field of wound care. Data were loaded into Epidata version 3.1 and analysed with SPSS version 16.0. RESULTS: The mean pre-training knowledge, skill, attitude and confidence scores were (117.78±24.94), (53.61±10.26), (54.39±8.02) and (1.18-3.59), respectively, while the corresponding post-training scores were (148.68±16.54), (62.33±8.40), (60.80±8.75) and (1.50-4.15) p<0.0001. CONCLUSIONS AND RECOMMENDATIONS: This was the first cohort to undergo the new training programme and has shown promising initial results; however, it also demonstrates that the training content, while leading to positive changes, does in some areas need to be further developed and then disseminated across the hospital to all nurses who provide direct wound care for patients.