Secondary Care Nurses Research Articles

Emergency management of neck stoma patients during the coronavirus pandemic: a national nurse survey.

Neck stoma patient care involves significant clinical complexity. Inadequate staff training, equipment provision and infrastructure have all been highlighted as causes for avoidable patient harm. To establish the perception of knowledge and confidence levels relating to the emergency management of neck stomas among UK nurses during the COVID-19 pandemic. A nationwide prospective electronic survey of both primary and secondary care nurses via the Royal College of Nursing and social media. 402 responses were collated: 81 primary care and 321 secondary care; the majority (n=130) were band 5. Forty-nine per cent could differentiate between a laryngectomy and a tracheostomy; ENT nurses scored highest (1.56; range 0-2) on knowledge. Fifty-seven per cent could oxygenate a tracheostomy stoma correctly and 54% could oxygenate a laryngectomy stoma correctly. Sixty-five per cent cited inadequate neck stoma training and 91% felt inclusion of neck stoma training was essential within the nursing curriculum. Clinical deficiencies of management identified by nurses can be attributed to a lack of confidence secondary to reduced clinical exposure and education.

Nurses’ decision-making about cancer patients’ end-of-life skin care in Wales: an exploratory mixed-method vignette study protocol

IntroductionPatients with cancer are at high risk of developing pressure ulcers at the end of life as a result of their underlying condition or cancer treatment. There are many guidelines...

Supporting deployed operations: are military nurses gaining the relevant experience from MDHUs to be competent in deployed operations?

To explore how peacetime employment of military nurses in the UK National Health Service Medical Defence Hospital Units prepares them to be competent to practise in their role on deployment. Military secondary care nurses are employed within UK National Health Service Trusts to gain clinical experience that will be relevant to their military nursing role. A two-stage grounded theory study using mixed methods: postal questionnaire survey and in-depth interviews. In stage one a postal questionnaire was distributed to all serving military nurses. Stage two involved 12 semi-structured interviews. The data from both parts of the study were analysed using grounded theory. Four categories and one core category were identified, which suggested that participants did not feel fully prepared for deployment. Their feelings of preparedness increased with deployment experience and decreased when the nature of injuries seen on deployment changed. Respondents argued that even when unprepared, they did not feel incompetent. The findings suggest that the peacetime clinical experience gained in the National Health Service did not always develop the necessary competencies to carry out roles as military nurses on deployment. This study highlights the unique role of military nurses. We discuss these findings in the light of the literature on competency and expertise. The military nurses in this study did not feel fully prepared for deployed operations. We propose a new model for how military nurses could gain relevant experience from their National Health Service placements. National Health Service clinical placements need to be reassessed regularly to ensure that they are meeting military nurses' clinical requirements. Experiences of nurses returning from deployment could be shared and used as a basis for reflection and learning within National Health Service Trusts and also inform decisions regarding the appropriateness of clinical placements for qualified military nurses.

Use of and Attitudes Toward Current Care Guidelines Among Primary and Secondary Care Nurses in Finland

Attitudes toward, familiarity with, and use of clinical guidelines in general and the national Hypertension Guideline were studied. A questionnaire study was conducted before and after an educational program (VALTIT) among primary and secondary care nurses in Päijät-Häme, Finland. The program included centralized training sessions and interactive local workshops. Prior to the program, a majority of nurses had a positive attitude toward guidelines but used guidelines seldom. Primary care nurses were better aware of the Hypertension Guideline than secondary care nurses, but the guideline was poorly used by both groups. At the follow-up, familiarity with the Hypertension Guideline and use of guidelines increased among primary care nurses. In future, primary care nurses will have a more autonomous role in patient care and should participate in clinical guideline development and related research. Our study has shown they are a potential target of such interventions.

Factors which influence nurse practitioners ability to carry out physical examination skills in the clinical area after a degree level module – an electronic Delphi study

The aim of the study was to identify the factors that influence nurse practitioners ability to practice physical examination skills in the clinical area. The changing health care needs of the population require new ways of working for many health professionals. Physical examination (core skills of inspection, palpation, percussion and auscultation) of patients is a fairly new role for nurses in secondary care in the United Kingdom. However, implementing new roles in the clinical area can be challenging for the practitioners involved, and several factors have been identified which are seen to help or hinder their success. A Delphi study was undertaken using blind copy email over six weeks in 2008. The participants included a purposive sample of 21 nurses from 10 clinical areas who had completed a degree level module in physical examination as part of a nurse practitioner pathway. This study generated valuable opinion of factors that can help or hinder the ability of nurses to practice physical examination in the clinical area. The results highlight the importance of individual self-confidence, role clarity, effective educational preparation and support from other disciplines to the nurse practitioners ability to carry out this new role. Several factors reported by the participants concur and add to factors reported in previous studies of new role implementation. There appears to be a continued need for clear job descriptions, role clarity, authority and autonomy to practice for nurse practitioners undertaking physical examination. Physical examination knowledge and skills are part of the role of nurse practitioners. This study highlights several factors which need to be addressed to ensure practitioners are able to carry out this new role on return to the clinical area.

Win a spa break for two by telling us what you think

Nursing Standard and independent data standards body GS1 UK need secondary care nurses to share their thoughts about hospital ward efficiency.

Systemic lupus erythematosus: the basics of nursing care

Systemic lupus erythematosis is a complex multi-system autoimmune disorder that frequently requires both physical and psychological care from nurses working in non-specialist areas. Both primary and secondary care nurses should have a working knowledge of this unfamiliar condition, so that they may support the patient with SLE at whatever stage of their care pathway. This article seeks to outline the important principles in lupus management for the non-specialist nurse, and to give some pointers towards informed care.

Nursing patients with epilepsy in secondary care settings

This article gives a brief overview of epilepsy and how a diagnosis is made. It highlights the importance of good observation and communication in its ongoing management. Long-term management of the condition and the acute management of seizures are considered. The article emphasises the effect on the individual, family and carers, identifies the key legislation and highlights the crucial role of secondary care nurses.

Journal scan

From spring 2006, qualified nurse prescribers will be able to prescribe any licensed medicine with the exception of controlled drugs. Most registered nurse prescribers work in primary care but secondary care nurses, especially those working in non-acute settings, are 'in an excellent position to improve patient care through prescribing'. Some decisions, such as whether to give capsules or syrup, can be made more easily by nurses because of their knowledge of the patient. Nurse prescribing in primary care has meant that patients receive treatment more quickly and this could be mirrored in hospitals.

The development of the nurse biopsy role

Research shows that nurse surgery posts strengthen continuity of care and allow collaboration with other health professionals to ensure patients receive appropriate and timely care. The consistent and integrated approach provided with the nurse biopsy role fills gaps in service provision and avoids duplication of services. Skin cancer is the most common cancer in the UK and at Queen's Medical Centre in Nottingham they see approximately 160 suspected cases each week. Before the introduction of the nurse biopsy role there was an 8-week wait for a biopsy by the doctor and a further 8-week wait for the removal of the tumour. Now, a patient with a suspected skin cancer can have a biopsy on the first visit to the clinic, reducing the wait from 8 weeks to 0 weeks. This reduction in waiting time facilitates improved mortality and morbidity from the skin cancer. It took 3 years to develop the nurse biopsy role in Nottingham and another 2 years to provide the service that is currently available. The nurse-led biopsy service is now being adopted nationwide, as recommended by the All Parliamentary Group on Skin (2003). The dermatology department at Queen's Medical Centre in Nottingham also runs an annual course to teach the surgery skills required to primary- and secondary-care nurses.

Devising and establishing the face and content validity of explicit criteria of consultation competence for UK secondary care nurses

Aim: The aims of this study were (a) to devise a set of prioritised criteria of consultation competence for UK secondary care nurses, and (b) to determine their face and content validity. Method: The criteria of consultation competence as contained in the Consultation Assessment and Improvement Instrument (CAIIN) for primary care nurses were adapted as a result of focus group discussions and observation of videotaped consultations with nurses working in secondary care. The amended criteria were sent to a sample of nurse consultants, specialist nurses and nurse practitioners ( n=394) to determine their face and content validity. Results: Support for the seven categories of consultation competence varied from 96% to 99% and for the 37 component competences from 94% to 99%. There was no consensus for alternative or additional categories or components. 87% of respondents strongly agreed or agreed that the categories of consultation competence should be prioritised and 63% strongly agreed or agreed with the suggested weightings. Conclusion: We have devised prioritised criteria of consultation competence of UK secondary care nurses and established their face and content validity. This can now facilitate the assessment and improvement of the consultation competence of secondary care nurses for both formative and regulatory purposes.

The progress of nurse prescribing in the United Kingdom

Nurse prescribing in England has made great strides in recent years. Building on the success of district nurse and health visitor prescribing – more than 23000 community nurses are now qualified to prescribe from the Nurse Prescribers’ Formulary for district nurses and health visitors – we implemented the extension to nurse prescribing from April 2002. This enabled nurses in secondary care, and midwives, to prescribe for the first time. The Nurse Prescribers’ Extended Formulary (NPEF), from which they can prescribe, includes all Pharmacy and General Sales List medicines that are prescribable by GPs, and a list of around 140 Prescription–only Medicines to treat conditions in four clinical areas: minor injuries, minor illness, health promotion and palliative care. Training to prescribe from the NPEF involves 25days of university-based education and 12days learning in practice, with the support of a medical prescriber. Around 800 nurses and midwives have already trained to prescribe from the NPEF. They include practice nurses, nurse practitioners and specialist nurses from acute hospitals, as well as nurses from emergency departments and Walk-in Centres.

Integrating primaryand secondary care — continuing education for acute and community nurses

The current emphasis on shorter hospitalstays and increased care in the community has led to a greater focus on integration of patient care between primary and secondary health care settings. The module which is discussed in this paper aims to address the knowledge gaps of trained nurses, enabling them to understand current changes in health care in order to enhance their practice. Flexibility in pre-registration education allows for incorporation of this new knowledge as changes occur. A situational analysis approach was used to inform the curriculum, and wide consultation took place with service providers in both hospital and community. The resulting first module addresses care in the community, influences on patient/client's health experience, current social policy and local initiatives in response to legislation, and role of carers. Assessment takes the form of a client profile. To date evaluation of the module has been extremely positive and the curriculum planning team are developing a more practice focused second module which will address skills. It is hoped that knowledge gained from both modules will enhance practice and form an initial preparation for secondary care nurses wishing to move into the community.