Continuous pressure monitoring of inpatient spinal cord injured patients: implications for pressure ulcer development.

STUDY DESIGN: Cohort observational study. OBJECTIVES: To examine the movement profiles of individuals with spinal cord injury (SCI) during their inpatient rehabilitative phase using continuous pressure monitoring (CPM), evaluating the trends in those with skin damage. SETTING: SCI specialist rehabilitation centre in the United Kingdom. METHODS: Individuals with SCI (n = 12) were assessed using CPM in the bed and chair over a 24-72 h. Pressure data was used as a surrogate for movement using both nursing interpretation and an intelligent algorithm. Clinical features were obtained including participants age, injury level, ASIA score, co-morbidities and prescribed support surfaces. Trends between movement profiles (frequency and intervals), SCI demographics and observed skin damage were assessed using cross-tabulation and histograms. RESULTS: The data revealed significant correlations (p < 0.05) between the nursing observation and algorithm for predicting movement, although the algorithm was more sensitive. Individuals with high level injuries (C1-T6) were observed to have a lower frequency of movement and larger intervals between movements when compared to low level injuries (T7-L5) during both lying and sitting periods. The individuals observed to have skin damage were predominantly those who had both a low frequency of movement and extended gaps between movements. CONCLUSIONS: Movements for pressure relief in both the bed and chair environments were dependent on the level of injury in individuals with SCI during their inpatient rehabilitation. Distinct movement patterns corresponded with those who acquired skin damage, revealing the potential clinical applications for technologies to monitor PU risk and inform personalised care.

Developing effective nurse leadership skills.

Leadership is a role that nurses are expected to fulfil, regardless of their job title and experience. Nurses are required to lead and manage care as soon as they have completed their training. However, the development of leadership skills and the associated learning can be challenging, especially for less experienced nurses and those at the beginning of their careers. This article examines the importance of effective leadership for nurses, patients and healthcare organisations, and outlines some of the theories of leadership such as transformational leadership. It also details how nurses can develop their leadership skills, for example through self-awareness, critical reflection and role modelling.

OSCEs--seven years on the bandwagon: the progress of an objective structured clinical evaluation programme.

The original purpose of Objective Structured Clinical Examination (OSCE), as first described in the medical literature [Harden, R.M., Stevenson, M., Downie, W.W., Wilson, G.M., 1975. Assessment of clinical competence using objective structured examination. British Medical Journal, 1, 447-451], provided a means of examining the skills acquisition of medical students. A review of the literature, since that time, provides the background to the development of OSCEs into pre-registration nursing curricula, with the OSCE programme at the University of Salford presented here as a case study. The original student sample was a mixture of 150-250 adult, child and mental health students in each of seven cohorts over a period of four years. Each student undertook a 30-min formative, simulated patient, holistic care OSCE in their second year of the programme. Later developments included one remote workstation connected to and as part of the holistic patient care encounter. In subsequent curricula, the larger cohorts of around 250-300 students were accommodated in a formative rotational three-workstation OSCE, based on clinical skills to be acquired prior to their first clinical placement. A summative patient-centred OSCE was undertaken in practice at a later date. The educational and practice value of OSCEs regarding their clinical content and context in nursing curricula now and in the future are explored, along with the practicalities of implementation.