Administration of medication in the acute mental health ward: perspective of nurses and patients.

The administration of medication is an important therapeutic intervention. However, concerns have been raised about the management of this procedure in the acute area. Therefore, a survey was conducted with registered nurses (n = 24) and patients (n = 57) from three acute admission wards in an inner city hospital in the north west of England. Semistructured interviews were conducted immediately following medication administration and then analyzed using thematic analysis. Nurses' views were categorized into three themes: ward environment, communication, and sharing of information. Nurses reported that policies and procedures provided clear guidance, but that the task remained stressful and the role of other professionals affected the integrity of the procedure. Patients' views were categorized into four themes: effects and side-effects of medication, the process of administration, therapeutic relationships, and the sharing of information. Most patients were accepting of the administration of their medication, but called for improvements in information sharing and side-effect management. Information sharing is pivotal in establishing therapeutic relationships, but the time of administration might not be the most appropriate occasion for this.

A systematic review of informal caregivers' needs in providing home-based end-of-life care to people with cancer.

AIMS: This paper presents the results of a systematic review examining the practical information needs of informal caregivers providing home-based palliative and end-of-life care to people with advanced cancer. BACKGROUND: Modern hospice care has led to increases in home-based palliative care services, with informal caregivers assuming responsibility for the majority of care. In response, health policy emphasises the provision of palliative care services in which both the patient and carer receive adequate support throughout illness and death. While the emotional needs of carers have been extensively researched, their practical needs with respect to the provision of physical care are yet to receive systematic attention. DESIGN: Systematic review. METHODS: Eligible articles were identified via electronic searches of research and evidence-based databases, hand-searching of academic journals and searches of non-academic grey literature websites. Quality of research was assessed via accepted guidelines for reviewing non-randomised, observational and qualitative literature. Data were synthesised by comparing and contrasting the findings to identify prominent themes. RESULTS: Research consistently highlights this lack of practical support, often related to inadequate information exchange. These deficits typically manifest in relatives adopting a 'trial and error' approach to palliative care. Informal carers request a greater quantity of practically-focussed information, improvements in quality and increased methods of dissemination. CONCLUSION: Synthesis of the literature suggests that home-based palliative care services have been insufficiently focussed on assisting informal caregivers acquire practical nursing skills. RELEVANCE TO CLINICAL PRACTICE: Enhanced access to professional advice represents a potentially effective method of increasing carers' confidence in their ability to undertake practical aspects of home-based care. Evidence suggests that nurses and other health providers may better assist home-based carers by providing the information and skills-training necessary to facilitate this. This may necessitate the involvement of carers in the design and testing of new educational interventions.

Inside the medicine cabinet: making children's medicines a grown-up issue.

Children need medicines that are properly designed and formulated specifically for pediatric use. However, the majority of medicines prescribed for children have insufficient clinical data to support pediatric use or to determine how children will react to such medicines. In particular, children living with HIV/AIDS have limited access to pediatric-specific antiretroviral drugs used to fight the disease. Recent improvements to U.S. and European pediatric drug testing laws may help generate more drugs tested and approved for children, but more must be done to ensure that children do not lag behind in access to lifesaving AIDS medicines, particularly in resource-poor countries.

Service user views and expectations of UK-registered mental health nurses: a systematic review of empirical research.

OBJECTIVES: To review national (UK) literature in order to (i) examine service user and carer views of UK-registered mental health nurses; (ii) identify the diversity of populations from which these views have been collected; (iii) assess the methodological rigour of the current knowledge base and (iv) evaluate the extent to which service users and carers have been involved in the development and execution of this work. This paper reports only on service users' views. DESIGN: Systematic review. DATA SOURCES: Electronic and evidence-based databases, reference checking and hand searching of key academic journals, national policy and user/carer organisational websites. REVIEW METHODS: Two reviewers independently undertook study eligibility judgements and data extraction. Eligible studies were sub-classified according to service setting (inpatient/residential, community/non-residential or mixed/unspecified). Each study was assessed against key quality criteria. Data were synthesised in a narrative format. RESULTS: One hundred and thirty two studies were included in the review. The majority were small-scale academic studies biased towards white, adult service users. Few studies provided evidence of user collaboration. Service users regard mental health nursing as a multi-faceted role delivering practical and social support alongside more formal psychological therapies. Service users report inadequate information provision, poor inter-professional communication and a lack of opportunities for collaborative care. Service users perceive inpatient mental health nurses as particularly inaccessible. CONCLUSIONS: UK-registered mental health nurses should be equipped with both therapeutic clinical skills and generic skills associated with relationship building, engagement and communication. Future research should be conducted in collaboration with service users and include clear and effective mechanisms for the dissemination and implementation of research findings. In particular, the views of children and adolescents, the elderly and black and minority ethnic groups, currently under-represented in research, should be examined.

New circulating-water devices warm more quickly than forced-air in volunteers.

BACKGROUND: Newer circulating-water systems supply more heat than forced-air, mainly because the heat capacity of water is much greater than for that of dry warm air and, in part, because they provide posterior as well as anterior heating. Several heating systems are available, but three major ones have yet to be compared directly. We therefore compared two circulating-water systems with a forced-air system during simulation of upper abdominal or chest surgery in volunteers. METHODS: Seven healthy volunteers participated on three separate study days. Each day, they were anesthetized and cooled to a core temperature near 34 degrees C, which was maintained for 45-60 min. They were then rewarmed with one of three warming systems until distal esophageal core temperature reached 36 degrees C or anesthesia had lasted 8 h. The warming systems were 1) energy transfer pads (two split torso pads and two universal pads; Kimberly Clark, Roswell, GA); 2) circulating-water garment (Allon MTRE 3365 for cardiac surgery, Akiva, Israel); and 3) lower body forced-air warming (Bair Hugger #525, #750 blower, Eden Prairie, MN). Data are presented as mean +/- sd; P < 0.05 was statistically significant. RESULTS: The rate of increase of core temperature from 34 degrees C to 36 degrees C was 1.2 degrees C +/- 0.2 degrees C/h with the Kimberly Clark system, 0.9 degrees C +/- 0.2 degrees C/h with the Allon system, and 0.6 degrees C +/- 0.1 degrees C/h with the Bair Hugger (P = 0.002). CONCLUSIONS: The warming rate with the Kimberly Clark system was 25% faster than with the Allon system and twice as fast as with the Bair Hugger. Both circulating-water systems thus warmed hypothermic volunteers in significantly less time than the forced-air system.