Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.

AIMS AND OBJECTIVES: The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. BACKGROUND: Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work. SETTING: Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses. PARTICIPANTS: The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study. METHODS: Responses to two open questions posed in the questionnaire were the subject of a content analysis. RESULTS: A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong. CONCLUSIONS: Education of the public concerning the implementation of such roles is of crucial importance. RELEVANCE TO CLINICAL PRACTICE: Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong.

Using mixed methods David Plowright £24.99 224pp 9781848601086 1848601085 [Formula: see text].

INITIAL PERUSAL of the content of this publication did not reveal anything new. However, this book is well presented and has plenty of tables which help simplify what is often a dense subject.

Why do students fail to disclose health problems?

BACKGROUND: At the university where this study took place, pre-qualifying healthcare students had previously been enrolled on programmes and were found to have pre-existing and ongoing health problems, which caused difficulties for some students during clinical placements. AIM: To develop a web-based information zone dealing with students' concerns about fitness-to-practise issues. METHOD: A three-stage study involving an online student survey, in-depth student interviews and development of a university web-based information zone was carried out. RESULTS: The web zone's content is based on key areas of importance identified by students who participated in the study. CONCLUSION: Early indications show that prospective and current students regularly use the web zone, demonstrated by the number of site hits.

Obesity interventions for people with a learning disability: an integrative literature review.

AIM: This paper is a review of the effectiveness of non-surgical, non-pharmaceutical interventions designed to promote weight loss in people with a learning disability and how qualitative evidence on people's experiences and motivations can help understanding of the quantitative research outcomes. BACKGROUND: The health risks of obesity underline the importance of effective evidence-based weight loss interventions for people with learning disabilities as they are at increased risk of being overweight. DATA SOURCES: Papers published from 1998 to 2009 were identified through searches of the Cumulative Index for Nursing and Allied Health Literature, Proquest, Medline (PubMed), PSYCHINFO databases, and the Cochrane Library. REVIEW METHODS: An integrative review method was used. Studies included were non-surgical or non-pharmaceutical interventions aimed at weight reduction for people with a learning disability. Synthesis of the findings related to study design, participants, types of interventions, outcome measures and participant perspectives. RESULTS: Twelve studies met the inclusion criteria. The most common research design was quasi-experimental pretest and post-test. Few researchers used a clinical trial approach, and there was only one predominantly qualitative study. Interventions were mainly focused on energy intake, energy expenditure or health promotion. Only a few studies incorporated behaviour modification approaches. CONCLUSION: Nurses who work with clients with learning disabilities have a key role to play in the management of obesity. Future research needs to focus on qualitative studies of the perceptions of clients and their families, controlled trials investigating the effectiveness of interventions and their costs and sustainability, and longitudinal studies examining weight loss over time.

An evaluation of an online numeracy assessment tool.

AIM: To evaluate users' perceptions of an online numeracy assessment tool in terms of improving their numeracy and confidence in mathematical calculation. METHOD: A quantitative and qualitative survey evaluation was performed. An online questionnaire was sent to 695 users of the tool. A response rate of 46% was achieved. Questions posed related to three broad areas: the respondents' mathematical qualifications and perceived level of competence, perceptions of the practice exercises and assessment, and the usability and design of the numeracy assessment tool. FINDINGS: After accessing the online numeracy tool, 23% of users undertook additional study to enhance their numeracy; 88% passed the practice assessment first time; 66% reported that the practice calculations reduced their anxiety about the final non-medical prescribing assessment; and 96% found the tool easy to use. CONCLUSION: Competence in numeracy is an important skill for all healthcare professionals, including prescribers. The numeracy assessment tool enables poor numeracy skills to be identified and support provided to improve the calculation skills of clinical staff.

Qualitative evaluation of a young carers' initiative.

This focus of this article is a qualitative, evaluative study of three Crossroads young carers projects. Focus group discussions took place with 24 young people aged 11-16 years. Data were analysed using a thematic content analysis approach. The themes of the research were: experiences of being a young carer, peer support, opportunities for time out and purposeful activities. The personal characteristics of the participants give rise to a number of worrying conclusions, that relatively young people were found to be undertaking primary caring roles over long periods of time. However, the groups were found to provide opportunities for young carers to experience a positive environment, participate in purposeful activities and have the chance to develop new friendships. Nevertheless, the literature suggests that provision of such projects is inadequate and under-resourced, which may disadvantage further a group of young people who are known to come from lower income families.

Endotracheal suctioning in children with severe traumatic brain injury: a literature review.

AIM: This paper aims to present an overview of the literature relating to the effects of endotracheal suctioning (ETS) in children and adults with severe traumatic brain injury (TBI). BACKGROUND: TBI is the leading cause of death in children worldwide and continues to result in widespread mortality and morbidity. In intensive care, ETS is an essential nursing procedure that is undertaken but is known to produce some adverse effects in children. METHOD: A comprehensive literature search was undertaken using a Parahoo and quality of reporting of meta-analyses (QUOROM) approach. A range of databases was searched to identify published papers with key search terms. The databases searched included Cochrane Library, Medline, PubMed Central, CINAHL, Proquest and Science Direct. FINDINGS: This review is based on 21 papers (with 433 patients in total), but specific papers in paediatric head injury children were extremely limited, and the evidence was largely dated and inconclusive. Although the majority of papers demonstrate an increase in intracranial pressure (ICP) with ETS, there are contradictory results with regard to recovery times. CONCLUSIONS: Further research is needed specifically into the effect of ETS on ICP and cerebral perfusion pressure of children with severe TBI, taking into account all the known confounding variables.

Meticillin-resistant Staphylococcus aureus: the modern-day challenge.

There are numerous resistant microorganisms but meticillin-resistant Staphylococcus aureus (MRSA) is probably the most notorious. MRSA is a resistant variation of the common bacterium, Staphylococcus aureus, that has developed the ability to survive treatment with a number of beta-lactam antibiotics, including meticillin. The focus of this article is a narrative literature review concerning the challenge that MRSA presents to nurses and other healthcare workers. A historical overview of antimicrobial resistance and the origins of MRSA are given, together with the factors involved in the persistence of antimicrobial resistance. The relevant microbiology, pathogenesis and epidemiology of MRSA will be discussed to provide a detailed rationale for the contemporary management of this persistent, resistant organism.

Student nurse non-attendance in relation to academic performance and progression.

BACKGROUND: High levels of non-attendance are reported in nurse education programmes even though literal interpretation of UK national guidelines implies mandatory student attendance is a requirement for all elements of pre-registration undergraduate programmes. OBJECTIVES: To examine relationships between undergraduate student nurse non-attendance, academic performance and progression. DESIGN: A quantitative study using audit approaches was undertaken. PARTICIPANTS: The records of 1347 undergraduate student nurses who had studied at a university in the north west of England were analysed. METHODS: Following data coding and input into an SPSS database descriptive and chi-square analyses were conducted to explore the associations between non-attendance rates and age, sex, entry qualifications, year of study and degree classification. RESULTS: The characteristics of the sample were that the majority were female, aged under 21years and had 'A' level entry qualifications. Significant chi-square associations were found in regard of age at entry and entry qualifications with degree classification. Significant chi-square associations were also identified between degree classification and non-attendance across all three years of the programme. CONCLUSIONS: The findings that non-attendance is positively associated with degree outcome across all the three years of study are in keeping with the findings of several studies. Many of these findings will help inform future student attendance policies where the study was conducted and are insightful for other national and international institutions that offer nurse education programmes.

Methodological considerations of undertaking research with clinical mentors in the UK: a critical review of the literature.

The subject of this paper is critical review of the reported research approaches used when undertaking clinical mentor research in the UK. The term 'Mentor' is used to denote a clinical practitioner who is responsible for the teaching, assessing and supervision of student nurses undertaking clinical practice. Imperatives such as new quality assurances in the UK are cited as part of the rationale for conducting the review. In these new initiatives, clinical placements are viewed as an integral feature of Higher Education Institution's (HEI) nurse education provision. Within these new quality assurance processes, there is an emphasis on the importance of clinical learning environments and the impact that mentors have on student learning. A critical review of 19 reports that have clinical mentors as their target population was undertaken. Factors such as the subject areas of the studies reviewed, research methodologies, sampling issues, responses rates and ethical considerations were the focus of the critical appraisal. It was found that most studies used postal survey approaches. Methodological weaknesses were found to relate to such things as questionnaire design, sampling and poor response rates. It is concluded that the study gives further insights into the debate about the rigor of nursing research and particularly nurse education research and therefore is of interest not only to nurse education researchers but also to nurse researchers generally.

Improving influenza vaccination uptake among frontline healthcare workers.

Vaccination of healthcare workers against seasonal influenza is recommended to protect staff, their families and patients. This study reports the findings of a survey conducted to explore how to improve uptake of influenza vaccination among staff at a specialist NHS hospital Trust. Responses to the survey were received from 376 members of staff (a 38.6% response rate). Reasons reported by respondents for not being vaccinated included lack of access and beliefs about the efficacy of vaccination. The findings suggest that uptake could be improved by ensuring convenience and flexibility in vaccination provision.

Don't go with the 'FLO' - a student mobile texting service to enhance nursing student retention.

BACKGROUND: The review undertaken revealed that there is an abundance of literature concerning retention and the high levels of attrition among undergraduate students and of relevance here, nurse education. The study undertaken evaluated the use of mobile phone automated texts designed to provide information, support and reassurance to help alleviate the stress and anxieties that some undergraduate nursing students experience during the early phase of their studies and which can lead to some students leaving their programme. OBJECTIVE: The objective of the study was to evaluate how use of automated mobile phone texts, using a system known as FLO, could usefully supplement pastoral support, as an intervention to reduce attrition among undergraduate nursing students. DESIGN: A qualitative and quantitative evaluation was conducted using an open-ended questionnaire designed specifically for the study. PARTICIPANTS: The sample were two cohorts of undergraduate first year student nurses (n=178). Of these 123 (69%) signed up to FLO and 77 (63%) completed the evaluation form. METHODS: The evaluation form that was administered in a classroom situation one week after use of FLO had ceased. Data were analysed through use of a descriptive statistics and thematic analysis approaches. RESULTS: A range of key themes emerged from the analysis including that text messages were helpful and supportive, increased a sense of belonging to the University and encouraged retention. There were some unresolved issues concerning the costs incurred by participants when sending reply text messages. CONCLUSIONS: It is concluded that FLO or use of similar mobile phone protocols can be a useful addition to approaches to improve undergraduate nursing student retention rates.

Personal tutors' views of their role with pre-registration nursing students: an exploratory study.

The focus of this article is an exploratory qualitative study which examined personal tutors' views of their role within pre-registration nurse education. Following review of relevant literature and gaining ethical approval a sample of 10 personal tutors was purposively selected from the teaching staff at a University in the UK. Each personal tutor agreed to participate in an audio taped one-to-one, face-to-face, in-depth interview. Data were analysed using a thematic content analysis approach. Data themes identified included, the role of the personal tutor; perceptions of personal students; student attendance and progress issues and responding to issues disclosed by personal students. These themes were underpinned by the perceived over-riding importance in providing support to personal students. The unpopular patient syndrome is contrasted and compared with perceptions of successful and unsuccessful students. Whilst an all encompassing system of personal tutor support may require a high commitment of time and people resources it remains an important support mechanism for students.

Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory.

BACKGROUND: Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems. OBJECTIVES: To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom. DESIGN: Data of a longitudinal qualitative nature were collected and analysed using grounded theory. SETTINGS: First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks. PARTICIPANTS: A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement. METHODS: Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained. RESULTS: The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status. CONCLUSIONS: Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

Angel, handmaiden, battleaxe or whore? A study which examines changes in newly recruited student nurses' attitudes to gender and nursing stereotypes.

This article presents the findings of a comparative study, which investigated the attitudes of two groups of newly recruited student nurses to gender and nursing stereotypes. The 1992 sample (n=100) was a group of student nurses who were in their second day of studies of a Project 2000 type curriculum. The 2002 sample (n=96) were in their second month of studies of a "Fitness for Practice" curriculum [Fitness for Practice (the 'Peach Report'), UKCC, London, 1999]. Data were collected using a questionnaire, which utilised a Likert scale for measurement of attitudes to statements pertaining to gender and nursing stereotypes. The findings reveal significant differences between the characteristics of the two groups of students. For example, the 2002 group were generally older and had more healthcare experience. However, male representation in the sample groups was similar. The overall high scores and implied propensity towards beliefs in gender and nursing stereotypes in the 1992 study was found not to be the case for the 2002 sample. This is particularly true of most statements related to gender stereotypes, nursing as 'feminine', male nurse stereotyping and issues related to nurses' uniform. However, there is less evidence of changes in attitudes towards female nursing stereotypes with indecision being a general feature of both the 1992 and 2002 responses.

The public health roles of health visitors and school nurses: a survey.

This article describes a qualitative study that examined the family centre public health role of health visitors and the child-centre public health role of school nurses. A telephone survey of key health visitor and school nurse informants in the West Midlands was undertaken. Respondents to the survey were asked to give examples of practice that related to Holman's (1992) public health typology. A wealth of data were obtained, which included 344 different examples of practice interventions. The majority of examples of practice given by the respondents were categorized as primary preventive interventions. The least represented concerned community empowerment and health protection. The findings of the survey give evidence of the current transitional nature health visitor and school nurse practice. Identified is some reorientation in practice and adoption of currently advocated models of public health, which have community participation, empowerment, and health protection as essential features.

Issues surrounding professional portfolio development for nurses.

This article discusses issues that underpin professional portfolio development for registered nurses. The findings were informed by a review of the pertinent literature. The literature was obtained by undertaking searches of a number of electronic databases and hand searches of key journals. It was found that portfolio development has been a requirement for re-registration for a number of years. However, there appears to remain confusion and uncertainty among professionals regarding the meaning and implications of portfolio development for nurses. For example, in the review conducted, the terminology used was often found to be confusing and expectations of how a portfolio should look are unclear. Conclusions can be drawn that practitioners may be in a quandary of how to develop and present evidence in what is now a mandatory requirement for re-registration, the maintenance of a professional portfolio.

A context analysis of student training records dating from the 1950/1960s: what were desirable and undesirable student nurse characteristics?

AIM: The aim of this study is to identify what were desirable and undesirable student nurse characteristics in the 1950/1960s and relate them to those who had successfully completed the programme and gained State Registration and those who had not. A further aim was to undertake comparisons with modern day values of what are viewed as desirable traits in nurses. BACKGROUND: In the 1950/1960s student nurses were hospital employees. Nurse training was based in hospital training schools and coordinated by sister tutors. Learning about nursing largely took place in clinical settings where there was limited supervision of student nurses by qualified nurses. DESIGN: Content analysis approaches were used whereby positive and negative comments related to successful and unsuccessful completers were identified. METHODS: Data were extracted from individual training records relating to 641 student nurses. The records dated from 1955 to 1968. Clinical and training school reports were summarized by senior hospital figures such as the hospital matron. These reports were the focus of the analysis. FINDINGS: Desirable student nurse traits identified in the analysis were being a 'nice person', who is kind, compassionate and attentive to patients, conscientious, bright and intelligent. Other values such as being hard-working, reliable and punctual reflect that the students studied were primarily employees. Amenable to discipline and unquestioningly obeying a doctor's order also were part of the conventions of the time. Most negative comments related to the unsuccessful completers. CONCLUSIONS: New insights into what was viewed as desirable and undesirable nursing characteristics in the 1950/1960s are identified. These insights have national and international relevance.