Simple writing skills for students, part two: researching your subject.

This is the second in a three part series on skills for academic writing. This article gives a brief guide to the principles of using evidence to support ideas in academic writing, how to undertake simple literature searches and how to reference this evidence. The hierarchy and ranges of evidence available to support discussions in work are discussed, along with some guidance on using evidence from websites.

Mean arterial blood pressure and the assessment of acutely ill patients.

This article discusses the role of vital sign data collection in the acute setting when assessing patients at risk of or actually clinically deteriorating. Specifically, the article focuses on explaining the important concepts of mean arterial blood pressure and pulse pressure as indicators of clinical deterioration.

Reporting behaviours of nursing students who have experienced verbal abuse.

AIM: This paper is a report of a study exploring the reporting behaviours of nursing students who had experienced verbal abuse while gaining clinical experience. BACKGROUND: Under-reporting of incidents of verbal abuse has been identified internationally as a limitation leading to incomplete data collection when researching aggression in healthcare facilities. This can call into question conclusions, recommendations and policy initiatives based on the research. METHOD: Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one preregistration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. Fifty-one students (44.7%) reported verbal abuse and all of these gave details of the behaviours concerned. RESULTS: Thirty-two students (62.7%) of those reporting verbal abuse) stated that they had reported the incident and 19 (37.3%) of respondents stated that they had not. Only four incidents resulted in formal documentation. The most frequent feelings reported by respondents were embarrassment and feeling sorry for the abuser. CONCLUSION: Failure to document experiences of verbal abuse formally was prevalent and reporting practices were variable. Both higher education institutions and healthcare providers should consider establishing process for formal reporting and documenting of incidents of verbal abuse during nurse education, and students should have access to formal support services.

Verbal abuse experienced by nursing students.

AIM: This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. BACKGROUND: Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. METHOD: Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. FINDINGS: Experience of verbal abuse was reported by 45.1% of respondents, 34.5% had witnessed other students experiencing this and 65.5% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64.7% of cases, 15.7% involved visitors or relatives and 19.6% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. CONCLUSION: Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students.

The art of auscultation: evaluating a patient's respiratory pathology.

This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.

Considering theories of aggression in an emergency department context.

Internationally literature emphasises concern regarding the phenomenon of violence and aggression within the emergency field. This paper emphasises the important role education and training may play in reducing the risk of staff being exposed to violent or aggressive experiences. Furthermore, the paper emphasises, explores and discusses well recognised theories relating to aggression development. These theories can be used to explain both organisational strategies designed to minimise aggression in the emergency department and situational factors contributing to the development of aggressive interactions.

Characteristics of people who assault nurses in clinical practice.

This article discusses certain variables relating to the characteristics of people who assault nurses, including patients, relatives and friends. The author suggests that the nature of nurses' occupational roles and responsibilities puts them at risk in their work but that individual or organisational strategies can be developed to minimise this risk.

Factors that influence aggressive behaviour in acute care settings.

Patients with critical illness or severe trauma may feel fear, anxiety and powerlessness, which can lead to aggressive behaviour. This article examines factors that contribute to patient aggression in acute care areas and identifies how these incidents can be minimised.

Respiratory auscultation: how to use a stethoscope.

This article outlines the correct procedure for respiratory assessments using a stethoscope, how to use a stethoscope and how to interpret your findings.

Violence and aggression in the emergency department: factors impinging on nursing research.

This paper examines issues involved in the debate regarding the role of research in nursing. The authors take the example of violence and aggression in the emergency field to discuss methodological, philosophical, professional, logistical, power differentials and leadership theory that influence and explain the process of conducting research surrounding violence and aggression experienced by nurses working in emergency departments. The paper examines the importance of research and discusses practical issues that impinge or frustrate clinical nursing staff who wish to conduct original research.

Under-reporting of violent incidents against nursing staff.

This article examines factors that contribute to nurses failing to report incidents of violence and aggression in the clinical area and it develops the information published in a previous article (Ferns and Chojnacka 2005). Broader social factors are considered, including gender, violence experienced by women, the status of the nursing profession and bureaucratic structures that contribute to under-reporting. The life experiences of individual nursing staff play a significant role in how they react to violence in the clinical area. Strategies to minimise violence against nurses should consider the social, political and personal issues that limit the reporting of violent incidents. Only by reporting such incidents can the extent of violence towards nurses be determined and minimised.

Violence, aggression and physical assault in healthcare settings.

All healthcare professionals are at risk from violent and aggressive patients, however, it has been found that nurses are at particular risk. The actual incidence is difficult to determine because the definition of what constitutes a physical assault or a violent event is vague. This article considers how the terms violence, aggression and physical assault are conceptualised in the healthcare setting and suggests that nursing staff need to identify and act on any incident that compromises their personal safety.

Conducting respiratory assessments in acute care.

Conducting comprehensive respiratory assessments involves extensive data collection and analysis and requires skill and knowledge. Terry Ferns and Irena Chojnacka examine how to approach these assessments systematically and professionally.

Violence in the accident and emergency department--an international perspective.

Violence and aggression experienced by emergency nurses has been the focus of international concern. This paper examines the phenomena of violence experienced by emergency department nursing staff from an international perspective by reviewing original, published research studies. Methodological inconsistencies and concerns, a lack of comprehensive studies and persistent under-reporting may mean that the reality of clinical practise has not being captured by researchers. The literature suggests that clients presenting with weapons in the emergency department may be characteristic of North American departments but is much less likely to occur in the United Kingdom were weapons use is much more likely to be opportunistic. Excessive verbal abuse is a global phenomenon and nursing staff and organisations may be significantly affected by workplace violence. However, violence against nursing staff remains poorly researched or understood.

Terminology, stereotypes and aggressive dynamics in the accident and emergency department.

There is a perception that violence against staff practising in accident and emergency (A&E) departments is increasing [Fernandes, C.M.B., Bouthillette, F., Raboud, J.M., Bullock, L., Moore, C.F., Christenson, J.M., Grafstein, E., Rae, S., Ouellet, L., Gillrie, C., Way, M., 1999. Violence in the emergency department: a survey of health care workers, Canadian Medical Association Journal 11, 1-6; Jenkins, M.G., Rocke, L.G., McNicholl, B.P., Hughes, D.M., 1998. Violence and verbal abuse against staff in the A and E departments: a survey of consultants in the United Kingdom and Republic of Ireland, Journal of Accident and Emergency Medicine 15, 262-265; . A survey of violence towards nursing staff in one large Irish Accident and Emergency department, Journal of Emergency Nursing 23(3), 214-219]. This paper discusses traditional stereotypes of the violent A&E client by critiquing the current literature. The paper then goes on to question whether some health care professionals themselves are contributing to a climate of fear and the development of conflict.

Angels and swingers, matrons and sinners: nursing stereotypes.

Media sexual stereotyping of the nursing profession is a well-recognized phenomenon; however the sexual stereotyping of the image of the nurse by the sex/pornography industry is a much less publicized or discussed phenomenon within the nursing profession. This paper aims to examine the presentation of the sexual stereotyping of nurses by newspapers and the sex/pornography industry. Both national and local newspapers in the UK frequently use derogatory terminology to depict the sexual stereotyping of nurses. Images and sexual stereotyping of nursing by the sex industry is also noted. The media was found to emphasize both positive and negative nursing stereotypes and in comparison with other occupations and professions sexual stereotyping was prevalent. The utilization of nursing imagery is also significantly visible across a wide range of pornographic and sex industry material.

A balanced approach to dealing with violence and aggression at work.

The Government has introduced tough measures in dealing with violence and aggression in the workplace. Employers have a duty to provide adequate safety measures and training to reduce risks and ensure, where possible, the health, safety and welfare of their employees. This article highlights the responsibilities of employers and the pressures in both hospital and community environments on staff at risk from violent or abusive incidents. The patient's perspective is discussed, suggesting that more understanding between patients and staff is needed. The article looks at the "NHS Zero Tolerance Zone Campaign" and whether this can be enhanced by introducing training of an empathetic nature along with other practical environmental issues. It suggests that there are alternative and more effective, techniques in dealing with violence and aggression that can be used to defuse a situation before it ever becomes a physical altercation. The philosophies of eastern martial arts can teach us a lot about personal self-esteem and confidence which are two key elements in managing conflict situations.

Personal safety in the accident and emergency department.

Violence and aggression continues to be a significant problem for staff practising in accident and emergency (A&E) areas. In recent years the number of articles examining factors related to violence and aggression in the A&E department have steadily increased, allowing for a more in-depth examination of data. This article considers the characteristics of individuals who assault A&E staff, introducing the reader to the "recreational fighter", an individual who enjoys and is attracted to violent confrontations. The article goes on to consider the role of gender, alcohol, age and social history in relation to the characteristics of individuals who assault nursing staff practising in A&E and offers a number of strategies for nursing staff to consider when attempting to minimize the risk of personal physical assault.

Reporting incidents of violence and aggression towards NHS staff.

Violence and aggression against nursing staff have been the subject of an ongoing campaign. However, incidents of violence continue to be under-reported. This article discusses factors leading to under-reporting of incidents and focuses on how nursing staffs' attitudes and responses to violence may contribute to the likelihood of reporting incidents. Change management techniques are proposed to address the under-reporting of incidents and to improve the work environment.

The causes of anaphylaxis and its management in adults.

Anaphylaxis is a potentially life-threatening condition which nurses may encounter while practising in any sphere of nursing. This article reviews the management of adults presenting with severe anaphylaxis in a general hospital setting. It summarizes data obtained from studies on the incidence of anaphylaxis, explains their significance, and defines the terms used when describing the pathophysiology of the condition. This is followed by an examination of the pathophysiology surrounding anaphylaxis with a summary of common causative agents. An overview of the management of patients with anaphylaxis is presented, together with a summary of the literature relating to the legal and ethical issues that nurses may face when encountering patients presenting with or experiencing anaphylaxis.